IMPLANTABLE LUMINAL DEVICES
An implant may include a frame and a cover to facilitate endoluminal vessel occlusion, selective release of embolic material toward a target region, and/or endoluminal stenting. The frame of the implant provides radial expansion properties to secure the cover within a body vessel. The cover and/or the frame can occlude flow of a fluid through the body vessel.
This application is a divisional of U.S. patent application Ser. No. 14/304,869, filed on Jun. 13, 2014, which claims the benefit of priority as a continuation-in-part of U.S. patent application Ser. No. 14/101,171, filed on Dec. 9, 2013, and claims the benefit of priority as a nonprovisional of U.S. Provisional Application No. 61/835,406, filed on Jun. 14, 2013, U.S. Provisional Application No. 61/835,461, filed on Jun. 14, 2013, U.S. Provisional Application No. 61/836,061, filed on Jun. 17, 2013, U.S. Provisional Application No. 61/900,321, filed on Nov. 5, 2013, U.S. Provisional Application No. 61/904,376, filed on Nov. 14, 2013, U.S. Provisional Application No. 61/904,379, filed on Nov. 14, 2013, and U.S. Provisional Application No. 61/939,659, filed on Feb. 13, 2014, the entirety of each of which is incorporated herein by reference.
FIELDThe subject technology relates generally to apparatuses and methods for blood vessel occlusion and vascular stenting.
BACKGROUNDRapid, well-controlled, and safe methods to limit bleeding in vessels have encouraged the development of endovascular devices and techniques, and their introduction into clinical practice. Early devices used balloons, either non-detachable or later detachable, in order to block vessels, for example, in the treatment of carotid-cavernous fistulas and saccular aneurysms.
Typically made from latex or silicone, balloons are delivered to a desired location in a vessel, then inflated in order to physically occlude the vessel. While other devices have since been developed, balloon occlusion remains in use, and is indicated for use in treating a variety of life-threatening conditions, including for example, giant cerebral and skull base aneurysms, traumatic and non-traumatic vessel injury or rupture, vertebro-vertebral arteriovenous fistulas, and pre-operative tumor resections.
Detachable balloons are also useful clinically in procedures outside of neurological intervention. For example, balloons can be useful in flow reduction procedures such as shunt occlusion in patients with transjugular intrahepatic portosystemic shunts and hepatic insufficiency, intrahepatic arterioportal fistulas, treatment of varicoceles, shunt occlusion in patients with a Blalock-Taussig shunt, obliteration of pulmonary arteriovenous fistulas, arteriovenous malformations or aortopulmonary anastomoses, coronary arteriovenous fistulas, or renal arteriovenous fistulas. Detachable balloons are also used in preoperative devascularization before surgical resection of organs such as the kidney.
Calibrated flow reduction is required during treatment of various medical conditions. For example, distal splenorenal shunt procedure (DSRS) (i.e., splenorenal shunt procedure or Warren shunt), is a surgical procedure in which the distal splenic vein attached to the left renal vein. This procedure can be used to treat portal hypertension, its main complication (esophageal varices), and other medical conditions, such as in pediatric patients with surgically created cardiac or pulmonary shunts (congenital heart disease).
Another related medical procedure is the transjugular intrahepatic portosystemic shunt or transjugular intrahepatic portosystemic stent shunting (commonly abbreviated as “TIPS” or “TIPSS”) is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension (which is often due to liver cirrhosis). Portal hypertension is a hypertension (high blood pressure) involving the portal vein system, which is composed by the portal vein, and its branches and tributaries. Portal hypertension may frequently lead to life threatening upper gastrointestinal bleeding (esophageal varices) and the buildup of fluid within the abdomen (ascites).
Normal values for portal vein pressure are between five and ten mmHg. Anything over 10 mmHg is elevated, while hypertension is over 12 mmHg. In clinical practice, the pressure is not measured directly until the decision to place a TIPS has been made. Corrected sinusoidal pressure (that is the wedged hepatic vein pressure minus free hepatic vein pressure) has generally been accepted as the minimally invasive gold standard for assessing the severity of portal hypertension.
A TIPS procedure becomes necessary when portal hypertension causes the left gastric vein and the umbilical vein to dilate, which causes venous blood to flow in reverse. This leads to varices in the esophagus and stomach, which in turn can lead to bleeding.
A TIPS procedure decreases the effective vascular resistance of the liver. The result is a reduced pressure drop across the liver sinusoids and a decreased portal venous pressure. This, in turn, lessens the pressure on the blood vessels in the esophagus so that future bleeding is less likely to occur. The reduced pressure also makes less fluid develop, although this benefit may take weeks or months to occur.
In order to perform TIPS procedure, an interventional radiologist creates the shunt using an image-guided endovascular (via the blood vessels) approach, with the jugular vein as the usual percutaneous entry site. In a TIPS procedure, a needle is introduced (via the jugular vein) and a tract is passed from the hepatic vein into the portal vein. Thereafter, the tract is dilated with a balloon. After placement of the tract, portal pressure is reduced and the coronary and umbilical veins no longer fill.
SUMMARYSome embodiments provided herein relate to vessel occlusion by delivery of radially expandable implant frames that achieve immediate total occlusion of blood flow. Frame configurations, expected delivered and expanded dimensions, and a description of target anatomy of some embodiments is provided.
Additionally, some embodiments provided herein relate to implantation in small blood vessels, such as from about 3 mm to about 20 mm, from about 5 mm to about 15 mm, or from about 7 mm to about 11 mm. The target delivery profile can be from about 2 Fr to about 6 Fr, and in some embodiments, from about 3 Fr to about 5 Fr.
Further embodiments can provide vascular stenting for vessels that are from about 3 mm to about 16 mm, from about 5 mm to about 13 mm, and in some embodiments, from about 7 mm to about 11 mm. The target delivery profile can be from about 2 Fr to about 8 Fr, about 3 Fr to about 7 Fr, from about 4 Fr to about 6 Fr, or in some embodiments, about 5 Fr. Additionally, expansion of the implant can provide sufficient radial force against the inside wall of a vein. Some embodiments can comprise features or means configured to minimize backflow of blood or minimize venous insufficiency. For example, treatment applications for embodiments of the device can include ilio-femoral venous obstruction and chronic iliac venous outflow obstruction as a result of venous disease.
Embodiments of the implants provided herein can be manufactured via several methods including shape-setting of drawn wire, chemical etching of a NiTi sheet of material, laser cutting of a tubular member, such as a material sheet or tubing, and/or electrical discharge machining (EDM) of a tubular member, such as a material sheet or tubing.
The implants disclosed herein can comprise flexible and/or shape memory materials such that they may be distorted from an expanded shape to a smaller diameter or straight shape to allow for delivery to a target location by way of a minimally invasive catheter-based approach.
In accordance with some embodiments, the implant can comprise a frame and a cover material. The cover material can comprise ePTFE tubing, film, and/or suture for attachment purposes. Additionally, the cover material may be fibrous, mesh-like, or impermeable in density.
The implant frame and/or implant cover can comprise a collagen coating or collagen treatment to improve anchoring of the implant in the target vessel. The collagen can be configured to promote cell adhesion to implant materials, thereby facilitating improved support for the implant and vessel structure while acting as an anti-migration feature for the implant.
The implant frame can comprise a straight or constant diameter, a tapering diameter, or sections of variable diameter extending over its length, which can facilitate anchoring within a vessel and optimal deployment function.
Embodiments of the systems and devices disclosed herein address the unmet need for a device that can provide a fast, precise and reliable way to close a bodily lumen. The endoluminal occlusion system can include two major subsystems: a guide sheath assembly and an implant carrier assembly. The implant carrier assembly can include an implant device and a handle assembly. Embodiments of the present disclosure can also comprise various features disclosed in U.S. Pat. No. 8,328,840, issued on Dec. 11, 2012, the entirety of which is incorporated herein by reference.
A single wire can be shaped in a back-and-forth pattern around a circumference. The shape can be set to an expanded diameter to fill the circumference of a blood vessel. The ends of the wire can be welded or otherwise attached such that there is a continuous construct around the full circumference. The design can be intended to allow a high ratio of expansion, while maintaining a radial force at all points around the circumference of the blood vessel in order to seal blood flow. The construct can be covered with a non-permeable material, sealed at one or both ends to occlude blood flow. The cover can be silicone rubber, ePTFE, or urethane, and designed to have a tight fit around the expanded construct. The construct size can be chosen based on endoluminal size at the implant location, expected to be a minimum 25% greater in diameter than the endoluminal diameter.
An expandable feature (braid, balloon, or other construct) with a non-permeable cover can be attached to a filament shaped into a coil. The expandable feature can utilize shaped or otherwise positioned wires such that axial compression of the expandable feature causes a diameter increase intended for occlusion of a blood vessel. The expandable feature can alternatively increase in diameter by internal pressure caused by an expandable gel or other material, or insertion of liquid. The coil can be shape set to a corresponding diameter relative to the expandable feature, and acts to anchor the expandable occlusion feature within a blood vessel or vascular malformation such as fistula, etc.
According to some embodiments, medical methods and apparatuses are provided for controlling or modifying a pressure gradient between blood vessels. Further, some embodiments can provide an adjustable implant that can be modified to provide a desired pressure gradient. The implant can be adjusted from a first non-zero flow rate to a second non-zero flow rate, and in some embodiments, from the second non-zero flow rate to a third non-zero flow rate, to provide a variety of gradient options. For example, the implant can be modified in situ. Further, some embodiments can provide methods and implants for adjusting a hepatic venous pressure gradient (HVPG) between the portal and hepatic veins in a transjugular intrahepatic portosystemic procedure. Such methods and apparatuses can be configured to adjust or maintain the HVPG equal to or below about 10 mmHg.
Frame configurations, expected delivered and expanded dimensions, and a description of target anatomy of some embodiments are provided. Aspects of implants, catheters, and delivery devices that can be utilized in combination with the implants, systems, methods, and features disclosed herein are disclosed in: U.S. patent application Ser. No. 12/826,593, filed on Jun. 29, 2010 (086538-0012); U.S. patent application Ser. No. 13/367,338, filed on Feb. 6, 2012 (086538-0018); U.S. patent application Ser. No. 12/906,993, filed on Oct. 18, 2010 (086538-0014); U.S. patent application Ser. No. 13/828,974, filed on Mar. 14, 2013 (086538-0030); U.S. Patent Application No. 61/836,061, filed on Jun. 17, 2013 (086538-0038); U.S. patent application Ser. No. 14/044,794, filed on Oct. 2, 2013 (086538-0039); U.S. patent application Ser. No. 14/281,797, filed on May 19, 2014 (086538-0055); U.S. Patent App. No. 61/835,406, filed on Jun. 14, 2013 (086538-0032); U.S. Patent App. No. 61/904,376, filed on Nov. 14, 2013 (086538-0041); U.S. Patent App. No. 61/904,379, filed on Nov. 14, 2013 (086538-0043); U.S. Patent App. No. 61/835,461, filed on Jun. 14, 2013 (086538-0034); U.S. Patent App. No. 61/900,321, filed on Nov. 5, 2013 (086538-0040); and U.S. patent application Ser. No. 14/101,171, filed on Dec. 9, 2013 (086538-0046), the entireties of which are incorporated herein by reference.
Some embodiments can provide vascular implantation for vessels that are from about 2 mm to about 16 mm, from about 5 mm to about 13 mm, and in some embodiments, from about 7 mm to about 11 mm. The target delivery profile can be from about 2 Fr to about 8 Fr, about 3 Fr to about 7 Fr, from about 4 Fr to about 6 Fr, or in some embodiments, about 5 Fr. Additionally, expansion of the implant can provide sufficient radial force against the inside wall of a vein. Some embodiments can comprise features or means configured to minimize backflow of blood or minimize venous insufficiency. For example, treatment applications for embodiments of the implant can include ilio-femoral venous obstruction and chronic iliac venous outflow obstruction as a result of venous disease.
The implant may serve as a calibrated flow and pressure reduction tool in some embodiments. Some embodiments of the implant can be used for purposes of tumor devascularization, reducing traumatic bleeding or hemorrhage, high-flow vascular malformations, vascular or airway volume reduction procedures, treatment of a target lesion, treatment and embolization of incompetent venous systems in low extremities (i.e., legs and lower abdominal area), treatment varicose veins in the leg (i.e., great saphenous vein and spider veins in deeper system), attending to other indications such as arterio-venous malformation (AVM), pelvic varices, etc.
Further, some embodiments provide an implant delivery system that comprises a catheter having a flexible, torque-resistant tip over which an implant frame may be secured and delivered to a target treatment site. Some embodiments also relate to engagement mechanisms whereby an implant can be engaged relative to a delivery catheter and actuation mechanisms for releasing the implant from the engagement.
The subject technology is illustrated, for example, according to various aspects described below. Various examples of aspects of the subject technology are described as numbered clauses (1, 2, 3, etc.) for convenience. These are provided as examples and do not limit the subject technology. It is noted that any of the dependent clauses may be combined in any combination, and placed into a respective independent clause, e.g., clause 1 or clause 55. The other clauses can be presented in a similar manner.
Clause 1. An expandable device for delivery to a target location in a body vessel, comprising: a first elongate member having (i) a first portion extending along an arcuate path in a clockwise circumferential direction, (ii) a second portion extending along an arcuate path in a counterclockwise circumferential direction, and (iii) a third portion interconnecting the first and second portions; and a second elongate member coupled to the first elongate member, the second member having (i) a first portion extending along an arcuate path in a counterclockwise circumferential direction, (ii) a second portion extending along an arcuate path in a clockwise circumferential direction, and (iii) a third portion interconnecting the first and second portions, wherein the first member third portion is coupled to the second member third portion to interconnect the first and second members, and wherein the first and second portions of the first and second members are spaced apart from each other to collectively define a frame having a central lumen extending therethrough.
Clause 2. The device of Clause 1, wherein the first portions of the first and second elongate members collectively define a first support element, and the second portions of the first and second elongate members collectively define a second support element, wherein the first support element has a cross-sectional profile different from the second support element.
Clause 3. The device of Clause 2, wherein the first and second support elements are circular.
Clause 4. The device of Clause 2, wherein the first and second elongate members each comprise fourth portions that interconnect the second portions with respective fifth portions, the fifth portion of the first elongate member extending along at least a portion of a cylindrical path in a clockwise circumferential direction, the fifth portion of the second elongate member extending along at least a portion of a cylindrical path in a counterclockwise circumferential direction, wherein the fifth portions of the first and second elongate members collectively form a third support element having a cross-sectional profile different from a cross-sectional profile of at least one of the first support element or the second support element.
Clause 5. The device of Clause 4, wherein the first, second, and third support elements are circular and have diameters different from each other.
Clause 6. The device of any of the previous Clauses, wherein in a relaxed position, the first portion and the second portion of the first elongate member both extend substantially parallel relative to each other and transversely relative to the third portion of the first elongate member, and wherein the first portion and the second portion of the second elongate member both extend substantially parallel relative to each other and transversely to the third portion of the second elongate member.
Clause 7. The device of any of the previous Clauses, wherein the frame is substantially conical.
Clause 8. The device of any of the previous Clauses, wherein the frame is substantially tubular.
Clause 9. The device of any of the previous Clauses, wherein the first and second members are configured to form a substantially tubular member in an expanded state and to be drawn into a substantially linear member in a delivery state.
Clause 10. The device of any of the previous Clauses, wherein the first and second members comprise pluralities of first, second, and third portions, and wherein the first and second members are interconnected along a length of the frame at respective third portions thereof.
Clause 11. The device of any of the previous Clauses, wherein the first and second members each define a respective portion of a cylindrical shape, the first and second members being interconnected to form a substantially cylindrical frame.
Clause 12. The device of any of the previous Clauses, wherein the third portions of the first and second members are coupled using a weld, adhesive, cuff, coil, or ring.
Clause 13. The device of any of the previous Clauses, wherein the device comprises a cover.
Clause 14. The device of any of the previous Clauses, wherein the device comprises a graft extending at least partially about the helical member.
Clause 15. The device of any of the previous Clauses, wherein the device comprises a graft extending around the helical member in a substantially tubular configuration and having opposing open end portions.
Clause 16. The device of any of the previous Clauses, wherein the device comprises a plurality of apertures and at least one filament extending between the apertures to form a web along at least a portion of the device.
Clause 17. The device of any of the previous Clauses, wherein the device comprises a partial cover positioned on the frame.
Clause 18. The device of any of the previous Clauses, further comprising a proximal coupling mechanism extending proximally from the first support element and a distal coupling mechanism extending distally from the third support element.
Clause 19. An expandable device for delivery to a target location in a body vessel, comprising: first, second, and third support elements, each comprising at least one wire extending in a circumferential direction to form a loop, each of the support elements extending generally orthogonally relative to a longitudinal axis of the device when the device is in a relaxed state; a first axial element interconnecting the first and second support elements at a first circumferential position; and a second axial element interconnecting the second and third support elements at a second circumferential position, offset from the first circumferential position by about 180°; wherein the first, second, and third support elements are resiliently biased to the relaxed state from a collapsed state in which the device extends in a substantially linear configuration.
Clause 20. The device of Clause 19, wherein the first, second, and third support elements comprise annular rings.
Clause 21. The device of any of Clauses 19-20, wherein the first, second, and third support elements comprise a pair of wires extending symmetrically about an axis of the device.
Clause 22. The device of any of Clauses 19-21, wherein the first and second axial elements comprise a pair of wires extending symmetrically about an axis of the device.
Clause 23. The device of any of Clauses 19-22, further comprising a proximal coupling mechanism extending proximally from the first support element and a distal coupling mechanism extending distally from the third support element.
Clause 24. An delivery system for delivering the expandable device of any of the previous Clauses, the system comprising a catheter having proximal and distal engagement mechanisms, the proximal and distal engagement mechanisms being releasably engageable with proximal and distal coupling portions of the device.
Clause 25. An expandable device for delivery to a target location in a body vessel, comprising an elongate helical member extending in a helical path and having a cross-sectional shape in which an axial width is less than a radial thickness.
Clause 26. The device of Clause 25, wherein the elongate helical member is configured to form a substantially tubular member in an expanded state and to be drawn into a substantially linear member in a delivery state.
Clause 27. The device of any of Clauses 25-26, wherein the helical member is configured to comprise a variable pitch.
Clause 28. The device of any of Clauses 25-27, wherein the helical member is configured to comprise a substantially constant pitch.
Clause 29. The device of any of Clauses 25-28, wherein the device comprises a cover.
Clause 30. The device of any of Clauses 25-29, wherein the device comprises a cover extending between the first and second members.
Clause 31. The device of any of Clauses 25-30, wherein the device comprises an occlusive structure extending at least partially about the helical member.
Clause 32. The device of any of Clauses 25-31, wherein the device comprises an occlusive structure extending around the helical member in a substantially tubular configuration and having opposing open end portions.
Clause 33. The device of any of Clauses 25-32, wherein the device comprises a plurality of apertures and at least one filament extending between the apertures to form a web along at least a portion of the device.
Clause 34. An implant delivery system, comprising the device of any of Clauses 25-33 and a catheter having a distal end portion and a deployment aperture extending through a sidewall of the catheter, the deployment aperture comprising a cross-sectional longitudinal width that is less than its cross-sectional axial height, wherein a distal end portion of the device is positioned within the deployment aperture.
Clause 35. The system of Clause 34, wherein a longitudinal axis of the aperture extends substantially orthogonally relative to the sidewall of the catheter.
Clause 36. The system of any of Clauses 34-35, wherein a longitudinal axis of the aperture extends transversely relative to the sidewall of the catheter.
Clause 37. A method of implanting an intraluminal device, comprising: advancing a catheter to a target location within a body vessel, the catheter having a distal end portion and a deployment aperture extending through a sidewall of the catheter, the catheter having a lumen in which the device is disposed, the device comprising a cross-sectional profile with a first dimension greater than a second dimension; and advancing the device out of the catheter through the deployment aperture with the cross-sectional profile oriented such that the first dimension extends in an axial dimension.
Clause 38. The method of Clause 37, wherein the cross-sectional profile is substantially rectangular.
Clause 39. The method of any of Clauses 37-38, wherein the device extends through the aperture in a direction substantially perpendicular relative to an outer surface of the catheter.
Clause 40. The method of any of Clauses 37-39, wherein a longitudinal axis of the device extends through the aperture substantially orthogonally relative to an outer surface of the catheter.
Clause 41. The method of any of Clauses 37-40, wherein a longitudinal axis of the device extends through the aperture in substantially transverse relative to an outer surface of the catheter.
Clause 42. The method of any of Clauses 37-41, further comprising placing a cover into the vessel.
Clause 43. The method of any of Clauses 37-42, further comprising positioning a graft at least partially about the helical member.
Clause 44. The method of any of Clauses 37-43, further comprising positioning a graft at least partially around the helical member in a substantially tubular configuration, the graft having opposing open end portions.
Clause 45. The method of any of Clauses 37-44, wherein the device comprises a plurality of apertures and at least one filament extending between the apertures to form a web along at least a portion of the device.
Clause 46. The method of any of Clauses 37-45, further comprising positioning a partial cover on the frame.
Clause 47. An expandable device for delivery to a target location in a body vessel, comprising: a proximal end portion; a distal end portion; a plurality of filaments attached to each of the proximal end portion and the distal end portion, extending helically about a central axis, and defining, in an expanded state, a proximal face, a distal face, and a cylindrical middle section between the proximal face and the distal face; and a cover disposed on a portion of the middle section and one of the proximal face and the distal face.
Clause 48. The expandable device of Clause 47, wherein each of the plurality of filaments extends in a helical direction that is the same as a helical direction of every other of the plurality of filaments.
Clause 49. The expandable device of any of Clauses 47-48, wherein the cover is disposed on each of the proximal face, the distal face, and the middle section.
Clause 50. The expandable device of any of Clauses 47-49, wherein the cover is attached to one of the proximal end portion and the distal end portion.
Clause 51. The expandable device of any of Clauses 47-50, wherein the cover blocks fluid flow from a region outside of the filaments to a region enclosed by the filaments.
Clause 52. The expandable device of any of Clauses 47-51, wherein the proximal face and the distal face each define a surface transverse to the central axis.
Clause 53. The expandable device of any of Clauses 47-52, further comprising a wire fixedly attached to one of the proximal end portion and a distal end portion, the wire being slidably connected to the other of the proximal end portion and the distal end portion.
Clause 54. The expandable device of any of Clauses 47-53, wherein the filaments have a compressed state, in which the filaments define a compressed diameter, less than an expanded diameter in the expanded state.
Clause 55. The expandable device of any of Clauses 47-54, wherein proximal end portion is attached to a distal end portion of a second expandable device by a connector.
Clause 56. An expandable device for delivery to a target location in a body vessel, comprising: a proximal end portion; a distal end portion; a plurality of struts attached to each of the proximal end portion and the distal end portion, extending longitudinally along a portion of a circumferential path, and defining, in an expanded state, a proximal face, a distal face, and an equator between the proximal face and the distal face; and a cover disposed on one of the proximal face and the distal face.
Clause 57. The expandable device of Clause 56, wherein the cover is disposed on each of the proximal face, the distal face, and the equator.
Clause 58. The expandable device of any of Clauses 56-57, wherein the cover is attached to one of the proximal end portion and the distal end portion.
Clause 59. The expandable device of any of Clauses 56-58, wherein the cover blocks fluid flow from a region outside of the struts to a region enclosed by struts.
Clause 60. The expandable device of any of Clauses 56-59, wherein the proximal face and the distal face each define a hemispherical section.
Clause 61. The expandable device of any of Clauses 56-60, further comprising a wire fixedly attached to one of the proximal end portion and a distal end portion, the wire being slidably connected to the other of the proximal end portion and the distal end portion.
Clause 62. The expandable device of any of Clauses 56-61, wherein the filaments have a compressed state, in which the struts define a compressed diameter, less than an expanded diameter in the expanded state.
Clause 63. The expandable device of any of Clauses 56-62, wherein each of the plurality of struts forms a proximal notch on an outer surface thereof at the proximal end portion and wherein each of the plurality of struts forms a distal notch on an outer surface thereof at the distal end portion.
Clause 64. The expandable device of any of Clauses 56-63, wherein each of the plurality of struts forms a middle notch on an inner surface thereof and between the proximal end portion and the distal end portion.
Clause 65. An expandable device for delivery to a target location in a body vessel, comprising: a hub; a plurality of filaments having a compressed state, such that the filaments extend axially from a side of the hub, and an expanded state, such that the filaments extend radially outwardly from the side of the hub; an expander being movable by a control rod from a first location distal of the filaments, such that the filaments are in the compressed state, to a second location, proximal of the first location and in which the expander contacts the filaments to transition the filaments to the expanded state; and a cover disposed across the plurality of filaments.
Clause 66. The expandable device of Clause 65, wherein the control rod is movable axially within the hub.
Clause 67. The expandable device of any of Clauses 65-66, wherein the filaments define an inner cross-sectional dimension in the compressed state, and the expander has an outer cross-sectional dimension greater than the inner cross-sectional dimension.
Clause 68. The expandable device of any of Clauses 65-67, wherein, in the expanded state, the filaments extend axially and radially from the side of the hub.
Clause 69. The expandable device of any of Clauses 65-68, further comprising: an enlarged member attached to the expander; an inner protrusion within the hub, configured to allow the enlarged member to move proximally through the hub past the inner protrusion and configured to prevent the enlarged member from moving distally through the hub past the inner protrusion.
Clause 70. The expandable device of Clause 69, wherein the enlarged member comprises a tooth having proximal slope and a distal side, and wherein the inner protrusion comprises a flexible pawl configured to ride up the proximal slope of the tooth and engage the distal side of the tooth.
Clause 71. The expandable device of any of Clauses 65-70, wherein the hub is attached to a hub of a second expandable device by a connector.
Clause 72. The expandable device of any of Clauses 65-71, wherein control rod is releasably attached to the enlarged member.
Clause 73. The expandable device of any of Clauses 65-72, wherein the expandable device tends to the compressed state when unrestrained.
Clause 74. A method of delivering an expandable device to a target location in a body vessel, comprising: providing a catheter to the target location, the catheter carrying the expandable device in a compressed state; and pulling an expander proximally relative to a hub of the expandable device, such that filaments extending distally from the hub expand radially outwardly from the hub to an expanded state, in which a cover over the filaments occludes fluid flow through the body vessel.
Clause 75. The method of Clause 74, wherein pulling the expander comprises pulling a control rod, connected to the expander, proximally through the hub.
Clause 76. The method of any of Clauses 74-75, wherein pulling the expander comprises pulling an enlarged member, connected to the expander, proximally past an inner protrusion within the hub, such that the inner protrusion prevents the enlarged member from moving distally through the hub past the inner protrusion.
Clause 77. The method of any of Clauses 74-76, wherein pulling the expander comprises pulling a control rod, connected to the expander, proximally through the hub.
Clause 78. The method of any of Clauses 74-77, further comprising: delivering a supplemental device within the body vessel, the supplemental device facing a direction opposite a direction of the expandable device; connecting the supplemental device to the expandable device.
Clause 79. An expandable device for delivery to a target location in a body vessel, comprising: a hub; a plurality of proximal filaments having a compressed state, such that the proximal filaments extend proximally and axially from a proximal side of the hub, and an expanded state, such that the proximal filaments extend radially outwardly from the proximal side of the hub; a proximal expander being movable by a control rod from a first location proximal of the proximal filaments, such that the proximal filaments are in the compressed state, to a second location, distal of the first location and in which the expander contacts the proximal filaments to transition the proximal filaments to the expanded state; a proximal cover disposed across the plurality of proximal filaments; a plurality of distal filaments having a compressed state, such that the distal filaments extend distally and axially from a distal side of the hub, and an expanded state, such that the distal filaments extend radially outwardly from the distal side of the hub; a distal expander being movable from a first location distal of the distal filaments, such that the distal filaments are in the compressed state, to a second location, proximal of the first location and in which the expander contacts the distal filaments to transition the distal filaments to the expanded state; and a distal cover disposed across the plurality of the distal filaments.
Clause 80. The expandable device of Clause 79, wherein the control rod is movable axially within the hub.
Clause 81. The expandable device of any of Clauses 79-80, wherein, in the expanded state, the filaments extend axially and radially from the side of the hub.
Clause 82. The expandable device of any of Clauses 79-81, further comprising: an enlarged member attached to the control rod; a lumen, within the proximal expander, configured to allow the enlarged member to move proximally through the proximal expander and configured to prevent the enlarged member from moving distally through the proximal expander.
Clause 83. The expandable device of Clause 82, wherein the enlarged member comprises a tooth having proximal slope and a distal side, and wherein the lumen comprises a flexible pawl configured to ride up the proximal slope of the tooth and engage the distal side of the tooth.
Clause 84. The expandable device of any of Clauses 79-83, wherein control rod is releasably attached to the enlarged member.
Clause 85. The expandable device of any of Clauses 79-84, wherein the expandable device tends to the compressed state when unrestrained.
Clause 86. A method of delivering an expandable device to a target location in a body vessel, comprising: providing a catheter to the target location, the catheter carrying the expandable device in a compressed state; and pulling a distal expander proximally relative to a distal expander of the expandable device, such that distal filaments extending distally from the hub and proximal filaments extending proximally from the hub expand radially outwardly from the hub to an expanded state, in which a cover over the proximal filaments and the distal filaments occludes fluid flow through the body vessel.
Clause 87. The method of Clause 86, wherein pulling the distal expander comprises pulling a control rod, connected to the distal expander, proximally through the proximal expander.
Clause 88. The method of any of Clauses 86-87, wherein pulling the expander comprises pulling an enlarged member, connected to the expander, proximally past the proximal expander, such that the proximal expander prevents the enlarged member from moving distally into the proximal expander.
Clause 89. An expandable device for delivery to a target location in a body vessel, comprising: a hub; a plurality of arms having a compressed state, such that the arms extend axially from a side of the hub, and an expanded state, such that the arms extend axially and radially outwardly from the side of the hub.
Clause 90. The expandable device of Clause 89, wherein the expandable device tends to the expanded state when unrestrained.
Clause 91. The expandable device of any of Clauses 89-90, wherein the arms are symmetrically distributed about a circumference of the hub.
Clause 92. The expandable device of any of Clauses 89-91, wherein the device has, in the expanded state, a maximum cross-sectional dimension at terminal ends of the arms.
Clause 93. A method of delivering expandable devices to a target location in a body vessel, comprising: providing a catheter to the target location, the catheter carrying a first expandable device and a second expandable device within a lumen of the catheter; advancing the first expandable device out of a distal port of the catheter, such that first arms of the first expandable device expand from a proximal orientation to a radial orientation; advancing the second expandable device out of the distal port of the catheter, such that second arms of the second expandable device expand from a distal orientation to a radial orientation, such that the first expandable device and the second expandable device overlap axially and such that each first arm is disposed between circumferentially adjacent second arms.
Clause 94. The method of Clause 93, wherein, while in the catheter, the first arms extend proximally from a first hub of the first expandable device and the second arms extend distally from a second hub of the second expandable device.
Clause 95. The method of any of Clauses 93-94, wherein advancing the first expandable device comprises pushing the first expandable device with the second expandable device.
Clause 96. The method of any of Clauses 93-95, wherein advancing the first expandable device comprises pushing the first arms with the second arms.
Clause 97. The method of any of Clauses 93-96, wherein advancing the second expandable device comprises pushing the second expandable device with a pusher disposed within the lumen and proximal to the second expandable device.
Clause 98. The method of Clause 97, further comprising, after advancing the second expandable device, detaching the pusher from the second expandable device.
Clause 99. The method of any of Clauses 93-98, wherein the first expandable device is advanced such that the first arms are angularly offset relative to the second arms while within the lumen.
Clause 100. The method of any of Clauses 93-99, wherein the second expandable device is advanced such that the first arms are angularly offset relative to the second arms while out of the port.
Clause 101. The method of any of Clauses 93-100, further comprising, after advancing the first expandable device and before advancing the second expandable device, advancing the catheter distally.
Clause 102. The method of any of Clauses 93-101, further comprising advancing the first expandable device toward the second expandable device such that first prongs extending from sides of the first arms engage second prongs extending from sides of the second arms.
Clause 103. The method of Clause 102, wherein advancing the first expandable device toward the second expandable comprises moving the first and second prongs past each other.
Clause 104. The method of any of Clauses 102-103, wherein edges of the first and second prongs are oriented to limit or prevent separation of the first and second expandable devices after the first and second prongs engage each other.
Clause 105. The method of any of Clauses 93-104, further comprising advancing the first expandable device toward the second expandable device with a tether detachably connected to at least one of the first expandable device and the second expandable device.
Clause 106. The method of any of Clauses 93-105, further comprising advancing the first expandable device toward the second expandable device with a band connected to the first expandable device and the second expandable device, the band being configured to shorten axially.
Clause 107. An expandable device for delivery to a target location in a body vessel, comprising: a first helical member having a proximal end portion, a distal end portion, and a first lumen extending between the proximal and distal end portions, the first helical member having an axial width that is greater than its radial thickness; and a second helical member having a proximal end portion coupled to first member proximal end portion, the second coil having axial width that is greater than its radial thickness, the second helical member extending radially within the first lumen.
Clause 108. The device of Clause 107, wherein each of the first helical member and the second helical member comprises a flat coil following a helical path.
Clause 109. The device of any of Clauses 107-108, wherein each of the first helical member and the second helical member comprises a substantially rectangular cross-sectional shape.
Clause 110. The device of any of Clauses 107-109, further comprising a first coupling member interconnecting the first helical member and the second helical member at an end portion of the device.
Clause 111. The device of any of Clauses 107-110, further comprising a second coupling member interconnecting the first helical member and the second helical member between the proximal end portion of the device and the distal end portion of the device.
Clause 112. The device of any of Clauses 107-111, wherein the first member radially overlaps the second member.
Clause 113. The device of any of Clauses 107-112, wherein the device is configured to form a substantially tubular member in an expanded state and to be drawn into a substantially linear member in a delivery state.
Clause 114. The device of any of Clauses 107-113, wherein the device comprises a cover attached to the device.
Clause 115. The device of any of Clauses 107-114, wherein the device comprises a cover extending radially between the first and second helical members.
Clause 116. The device of any of Clauses 107-115, wherein the device comprises a plurality of apertures and at least one filament extending between the apertures to form a web along at least a portion of the device.
Clause 117. An expandable device for delivery to a target location in a body vessel, comprising: at least one elongate member configured to form a frame defining a lumen, the elongate member comprising a plurality of apertures along a length thereof; and a filament extending through the plurality of apertures to form a mesh boundary on frame.
Clause 118. The device of Clause 117, wherein the frame is substantially cylindrical and the mesh boundary defines a portion of a substantially cylindrical surface.
Clause 119. The device of any of Clauses 117-118, wherein the filament comprises an elastic material.
Clause 120. The device of any of Clauses 117-119, wherein the frame extends in a substantially helical path to define a plurality of loops, and wherein the filament extends from a first aperture of the frame, across a lumen of the frame, and to a second aperture of the frame.
Clause 121. The device of Clause 120, wherein the filament extends across the lumen in a direction transverse to a central axis of the frame.
Clause 122. The device of any of Clauses 117-121, wherein the at least one elongate member comprises a coil formed from a flat wire.
Clause 123. The device of any of Clauses 117-122, wherein the filament interconnects a cover with the at least one elongate member, the cover extending along at least a portion of the device frame.
Clause 124. The device of any of Clauses 117-123, wherein the device comprises a cover.
Clause 125. The device of any of Clauses 117-124, wherein the device comprises a graft extending at least partially about the helical member.
Clause 126. The device of any of Clauses 117-125, wherein the device comprises a graft extending around the helical member in a substantially tubular configuration and having opposing open end portions.
Clause 127. The device of any of Clauses 117-126, wherein the device comprises a partial cover positioned on the frame.
Clause 128. An expandable device for delivery to a target location in a body vessel, comprising: a cover having an interior region and an open end; and a filament having (i) an expanded state in which the filament forms windings of a helical shape from a first side to a second side and within the interior region of the cover to hold the cover against a wall of the vessel and (ii) a compressed state, in which the filament is substantially linear.
Clause 129. The expandable device of Clause 128, wherein the first side has a first cross-sectional dimension, the second side has a second cross-sectional dimension, and a middle section between the first side and the second side has a middle cross-sectional dimension greater than each of the first cross-sectional dimension and the second cross-sectional dimension.
Clause 130. The expandable device of any of Clauses 128-129, wherein the helical shape is spherical.
Clause 131. The expandable device of any of Clauses 128-130, wherein the filament comprises a first end region and a second end region each forming a straight portion in the expanded state.
Clause 132. The expandable device of any of Clauses 128-131, wherein the cover has a closed end.
Clause 133. An delivery system to deliver an expandable device to a target location in a body vessel, comprising: a catheter having a lumen and a port; a cover having an interior region, a first end releasably attached to the catheter, and a second, closed end distal to the port; and a filament in a compressed, substantially linear state within the lumen, the filament being configured to expand when released from the catheter to form windings of a helical shape from a first side to a second side and within the interior region of the cover to hold the cover against a wall of the vessel.
Clause 134. The expandable device of Clause 133, wherein the interior portion is accessible to the lumen via the port.
Clause 135. The expandable device of any of Clauses 133-134, wherein the helical shape is spherical.
Clause 136. The expandable device of any of Clauses 133-135, wherein the filament comprises a first end region and a second end region, each forming a straight portion in the expanded state.
Clause 137. A method of delivering an expandable device to a target location in a body vessel, comprising: providing a catheter to the target location, the catheter having a first end of a cover attached to the catheter and a second, closed end distal to the catheter; advancing a filament from a compressed, substantially linear state within a lumen of the catheter to an expanded state forming windings of a helical shape from a first side to a second side and within an interior region of the cover, holding the cover against a wall of the vessel; and releasing the first end of the cover from the catheter.
Clause 138. The method of Clause 137, wherein the advancing comprises forming a straight portion in each of a first end region and a second end region of the filament while in the expanded state.
Clause 139. The method of any of Clauses 137-138, wherein the advancing comprises forming a spherical helix with the filament.
Clause 140. The method of any of Clauses 137-139, further comprising withdrawing the catheter from the body vessel.
Clause 141. The method of any of Clauses 137-140, wherein the second end of the cover is closed.
Clause 142. An assembly for delivering an implant to a target location in a body vessel, comprising: a catheter having a lumen and a distal port; a first expandable device disposed within the lumen and comprising (i) a first hub and (ii) a plurality of first arms extending proximally from the first hub, the first arms being configured to extend radially outwardly when released from the catheter; and a second expandable device disposed within the lumen proximal of the first expandable device and comprising (i) a second hub and (ii) a plurality of second arms extending distally from the second hub, the second arms being configured to extend radially outwardly when released from the catheter.
Clause 143. The assembly of Clause 142, further comprising a push or disposed within the lumen and proximal to the second expandable device.
Clause 144. The assembly of any of Clauses 142-143, wherein the first arms are angularly offset relative to the second arms.
Clause 145. The assembly of any of Clauses 142-144, further comprising a pusher disposed within the lumen and proximal to the second expandable device.
Clause 146. The assembly of Clause 145, wherein the pusher is detachably connected to the second hub.
Clause 147. The assembly of any of Clauses 142-146, wherein the first expandable device is deployable from the catheter while the second expandable device remains within the lumen.
Clause 148. The assembly of any of Clauses 142-147, wherein terminal ends of the first expandable device and the second expandable device provide complementary profiles, such that the first arms are angularly offset relative to the second arms when the first expandable device applies a force to the second expandable device.
Clause 149. The assembly of any of Clauses 142-148, wherein the first arms comprise first prongs extending from sides of the first arms, and second arms comprise second prongs extending from sides of the second arms.
Clause 150. The assembly of Clause 149, wherein edges of the first and second prongs are oriented to allow the first and second prongs to move past each other as the first and second expandable devices engage each other.
Clause 151. The assembly of any of Clauses 149-150, wherein edges of the first and second prongs are oriented to limit or prevent separation of the first and second expandable devices after the first and second expandable devices engage each other.
Clause 152. The assembly of any of Clauses 142-151, further comprising a tether detachably connected to at least one of the first expandable device and the second expandable device.
Clause 153. The assembly of any of Clauses 142-152, further comprising a band connected to the first expandable device and the second expandable device and configured to shorten axially when the first expandable device and the second expandable device are released from the catheter.
Clause 154. An implant, comprising: a proximal anchor; a distal anchor; a connection bridge connecting the proximal anchor to the distal anchor; an occlusive cover comprising an open proximal end and a closed distal end, wherein a portion of the occlusive cover is located about an outer radial surface of at least a portion of the distal anchor.
Clause 155. The implant of Clause 154, wherein the proximal anchor, in an unrestrained configuration, forms a helical coil winding about a central axis of the implant.
Clause 156. The implant of any of Clauses 154-155, wherein the distal anchor, in an unrestrained configuration, forms an undulating and circumferentially continuous path.
Clause 157. The implant of any of Clauses 154-156, wherein the distal anchor comprises a plurality of struts, the plurality of struts being connected to each other by proximal bends and distal bends.
Clause 158. The implant of Clause 157, wherein a circumferential width of each of the plurality of struts exceeds an axial width of the proximal bends and distal bends.
Clause 159. The implant of any of Clauses 157-158, wherein each of the plurality of struts is connected to (i) a first adjacent strut by one of the proximal bends and (ii) a second adjacent strut by one of the distal bends.
Clause 160. The implant of any of Clauses 157-159, wherein each of the plurality of struts is parallel to a central axis of the implant.
Clause 161. The implant of any of Clauses 154-160, wherein at least a portion of the connection bridge extends parallel to the central axis of the implant.
Clause 162. The implant of any of Clauses 154-161, wherein a radially smallest inner cross-sectional dimension of the distal anchor is located only at a distal end of the distal anchor, a proximal end of the distal anchor, or a middle section of the distal anchor.
Clause 163. The implant of any of Clauses 154-162, wherein a radially largest outer cross-sectional dimension of the distal anchor is located only at a distal end of the distal anchor, a proximal end of the distal anchor, or a middle section of the distal anchor.
Clause 164. The implant of any of Clauses 154-163, wherein the distal anchor comprises a plurality of circumferential rings, each of the plurality of circumferential rings forming a circumferentially continuous undulating path.
Clause 165. The implant of any of Clauses 154-164, wherein the connection bridge comprises a hoop that extends at least partially circumferentially about a central axis of the implant, over radially outward surfaces of first portions of the distal anchor and under radially inward surfaces of second portions of the distal anchor.
Clause 166. The implant of any of Clauses 154-165, wherein the distal anchor comprises a proximal section having a first outer cross-sectional dimension and a distal section that tapers along an axial length from the first outer cross-sectional dimension to a second outer cross-sectional dimension, less than the first outer cross-sectional dimension.
Clause 167. The implant of any of Clauses 154-166, wherein the distal anchor comprises a proximal section having a first outer cross-sectional dimension, a middle section that tapers along an axial length from the first outer cross-sectional dimension to a second outer cross-sectional dimension, less than the first outer cross-sectional dimension, and a distal section having the second outer cross-sectional dimension.
Clause 168. A method, comprising: advancing an implant within a body vessel to a target location, the implant comprising a proximal anchor, a distal anchor, and an occlusive cover; expanding the distal anchor until the occlusive cover is held radially between an outer surface of the distal anchor and a wall of the body vessel; and expanding the proximal anchor until the proximal anchor contacts the wall.
Clause 169. The method of Clause 168, wherein advancing the implant comprises restraining the implant in a collapsed configuration within a lumen of a catheter.
Clause 170. The method of any of Clauses 168-169, wherein expanding the distal anchor comprises advancing the distal anchor out of a lumen of the catheter through a distal port of the catheter.
Clause 171. The method of any of Clauses 168-170, wherein expanding the proximal anchor comprises advancing the proximal anchor out of a lumen of the catheter through a distal port of the catheter.
Clause 172. The method of any of Clauses 168-171, wherein expanding the distal anchor comprises allowing a plurality of longitudinal struts of the distal anchor to move radially outwardly.
Clause 173. The method of any of Clauses 168-172, wherein expanding the proximal anchor comprises advancing the proximal anchor out of a lumen of the catheter through a distal port of the catheter.
Clause 174. An implant, comprising: an anchor comprising a plurality of struts connected to each other by proximal bends and distal bends, the anchor forming an undulating and circumferentially continuous path; an occlusive cover comprising an open proximal end and a closed distal end, wherein a portion of the occlusive cover is located about an outer radial surface of at least a portion of the anchor.
Clause 175. The implant of Clause 174, wherein a circumferential width of each of the plurality of struts exceeds an axial width of the proximal bends and distal bends.
Clause 176. The implant of any of Clauses 174-175, wherein each of the plurality of struts is connected to (i) a first adjacent strut by one of the proximal bends and (ii) a second adjacent strut by one of the distal bends.
Clause 177. The implant of any of Clauses 174-176, wherein each of the plurality of struts is parallel to a central axis of the implant.
Clause 178. The implant of any of Clauses 174-177, wherein a radially smallest inner cross-sectional dimension of the anchor is located only at a distal end of the anchor, a proximal end of the anchor, and/or a middle section of the anchor.
Clause 179. The implant of any of Clauses 174-178, wherein a radially largest outer cross-sectional dimension of the anchor is located only at a distal end of the anchor, a proximal end of the anchor, or a middle section of the anchor.
Clause 180. The implant of any of Clauses 174-179, wherein the anchor further comprises a plurality of circumferential rings, each of the plurality of circumferential rings forming a circumferentially continuous undulating path.
Clause 181. The implant of any of Clauses 174-180, wherein the anchor comprises a proximal section having a first inner cross-sectional dimension and a distal section that tapers along an axial length from the first inner cross-sectional dimension to a second inner cross-sectional dimension, less than the first inner cross-sectional dimension.
Clause 182. The implant of any of Clauses 174-181, wherein the anchor comprises a proximal section having a first inner cross-sectional dimension, a middle section that tapers along an axial length from the first inner cross-sectional dimension to a second inner cross-sectional dimension, less than the first inner cross-sectional dimension, and a distal section having the second inner cross-sectional dimension.
Clause 183. A method, comprising: advancing an implant within a body vessel to a target location, the implant comprising an anchor and an occlusive cover, the anchor comprising a plurality of struts connected to each other by proximal bends and distal bends, the anchor forming an undulating and circumferentially continuous path; and expanding the anchor until the occlusive cover is held radially between an outer surface of the anchor and a wall of the body vessel.
Clause 184. The method of Clause 183, wherein advancing the implant comprises restraining the implant in a collapsed configuration within a lumen of a catheter.
Clause 185. The method of any of Clauses 183-184, wherein expanding the anchor comprises advancing the anchor out of a lumen of the catheter through a distal port of the catheter.
Clause 186. The method of any of Clauses 183-185, wherein expanding the anchor comprises allowing the plurality of struts to move radially outwardly.
Clause 187. An implant, comprising: a proximal anchor forming, in an unrestrained configuration, a helical coil winding about a central axis of the implant; a braided member having a center at the central axis, the braided member forming, in the unrestrained configuration, a sphere; and a connection bridge extending along the central axis and connecting the proximal anchor to the braided member.
Clause 188. The implant of Clause 187, further comprising an occlusive cover over the braided, spherical member.
Clause 189. A method, comprising: advancing an implant within a body vessel to a target location, the implant comprising a proximal anchor and a braided member; expanding the braided member until the braided member forms a sphere and contacts a wall of the body vessel; and expanding the proximal anchor until the proximal anchor forms a helical coil and contacts the wall.
Clause 190. The method of Clause 189, wherein expanding the anchor comprises advancing the anchor out of a lumen of the catheter through a distal port of the catheter.
Clause 191. An adjustable shunt system, comprising: a support member having a lumen and an outflow section, the support member being configured for placement in a body lumen, the outflow section comprising a distal aperture configured to restrict flow through the support member; and a valve component, disposed within the support member lumen, being movable within the outflow section between first and second positions, wherein in the first position, the valve component abuts at least a portion of the outflow section such that the distal aperture defines a first size permitting a non-zero flow rate therethrough, and in the second position, the valve component abuts the outflow section such that the distal aperture defines a second size, greater than the first size.
Clause 192. The system of Clause 191, wherein the valve component comprises a rigid structure having a fixed outer profile.
Clause 193. The system of any of Clauses 191-192, wherein the valve component comprises a rigid structure having a fixed outer profile.
Clause 194. The system of any of Clauses 191-193, wherein the outflow section comprises a plurality of movable leaflets biased towards a closed position, the leaflets being movable from the closed position to adjust the size of the aperture.
Clause 195. The system of any of Clauses 191-194, wherein the support member comprises a balloon-expandable structure, the outflow section being expandable such that the aperture increases from the first size to the second size.
Clause 196. The system of Clause 195, wherein valve component comprises a balloon-expandable structure, the valve component being expandable from the first position to the second position to expand the outflow section and expand the aperture to the second size.
Clause 197. The system of any of Clauses 191-196, wherein the outflow section comprises a substantially conical shape, and the valve component is slidable within the lumen such that in the first position, the outflow section has a first cone angle and in the second position, the outflow section has a second cone angle greater than the first cone angle.
Clause 198. The system of any of Clauses 191-197, wherein the valve component comprises an engagement structure configured to engage with the support member for fixing the valve component relative to the support member.
Clause 199. The system of any of Clauses 191-198, wherein the support member is configured to expand from a collapsed configuration to an expanded configuration for placement in a body lumen.
Clause 200. An adjustable shunt system, comprising: a support member having a lumen and an outflow section, the support member being configured for placement in a body lumen, the outflow section comprising a distal aperture configured to restrict flow through the support member; and a valve component, disposed within the support member lumen, being movable within the outflow section aperture between first and second positions, the valve component having an adjustable distal aperture being movable between a first size, permitting a non-zero flow rate therethrough, and a second size greater than the first size.
Clause 201. The system of Clause 200, wherein the outflow section aperture comprises a fixed diameter.
Clause 202. The system of Clause 201, wherein the valve component comprises a plurality of flexible leaflets deflectable from the first position to the second position to change the size of the valve component aperture.
Clause 203. The system of Clause 202, wherein the leaflets are configured to converge toward each other when the valve component is moved from the first position to the second position.
Clause 204. The system of Clause 201, wherein the valve component comprises a helical ribbon member movable from the first position to the second position to change the size of the valve component aperture.
Clause 205. The system of Clause 204, wherein the helical ribbon member comprises a first portion coupled to the support member and a free, second portion configured such that distal movement through the support member aperture constricts the ribbon member and reduces the size of the valve component aperture.
Clause 206. The system of any of Clauses 200-205, wherein the valve component comprises an engagement member configured to engage with a corresponding engagement member of the support member to axially restrain movement of the valve component relative to the support member.
Clause 207. The system of any of Clauses 200-206, wherein the outflow section aperture comprises a substantially conical shape.
Clause 208. A method of shunting comprising: advancing a shunt into a first vessel to provide a flow pathway from the first vessel into a second vessel; and adjusting a valve component of the shunt to control a flow resistance through an aperture of the valve component into the second vessel.
Clause 209. The method of Clause 208, wherein the advancing comprises advancing a shunt through a hepatic vein into a portal vein such that a first end of the shunt is disposed in the hepatic vein and a second end of the shunt is disposed in the portal vein.
Clause 210. The method of Clause 209, further comprising permitting expansion of the shunt to provide the flow pathway from the hepatic vein to the portal vein.
Clause 211. The method of any of Clauses 208-210, further comprising adjusting the position of the valve component within the shunt to modify a flow resistance through the shunt.
Clause 212. The method of Clause 211, wherein the adjusting the position of the valve component comprises detaching the valve component from a first position within the shunt and reattaching the valve component to the shunt at a second position within the shunt.
Clause 213. The method of any of Clauses 208-212, further comprising adjusting a shape of the valve component within the shunt to modify a flow resistance through the shunt.
Clause 214. The method of any of Clauses 208-213, further comprising adjusting the size of the aperture of the valve component to modify a flow resistance through the shunt.
Clause 215. The method of Clause 214, wherein the adjusting the size of the aperture comprises dilating the aperture with a balloon.
Clause 216. An assembly for delivering an implant to a target location within a body lumen, comprising: a catheter comprising a proximal portion, a distal portion, and a helical coil extending in a first helical direction and connecting the proximal portion to the distal portion, the coil being defined by a kerf between adjacent windings of the coil; and an implant comprising a first end portion, a second end portion, a torsion state, and a relaxed state, wherein the implant is biased to the relaxed state and wherein, while the implant is in the torsion state, the proximal portion engages the first end portion, the distal portion engages the second end portion, and the implant applies a torque to the catheter.
Clause 217. The assembly of Clause 216, wherein the kerf has a non-linear profile following a helical path.
Clause 218. The assembly of any of Clauses 216-217, wherein the implant further comprises a helical member extending in a second helical direction, opposite the first helical direction.
Clause 219. The assembly of any of Clauses 216-218, wherein, while the implant is in the torsion state, the adjacent windings of the coil are configured to contact each other.
Clause 220. The assembly of any of Clauses 216-219, wherein, while the implant is in the relaxed state, the adjacent windings of the coil are configured to be separated from each other.
Clause 221. The assembly of any of Clauses 216-220, wherein, while the implant is in the relaxed state, the proximal portion is configured to disengage from the first end portion and/or the distal portion is configured to disengage from the second end portion.
Clause 222. The assembly of any of Clauses 216-221, wherein, the non-linear profile comprises an undulating profile.
Clause 223. The assembly of any of Clauses 216-222, wherein, the non-linear profile comprises a triangular profile.
Clause 224. The assembly of any of Clauses 216-223, wherein, the non-linear profile comprises a sawtooth profile.
Clause 225. The assembly of any of Clauses 216-224, wherein the middle portion is configured to flex by separating the adjacent windings of the coil on a side of the middle section.
Clause 226. A method of delivering an implantable device to a target location in a body lumen, comprising: advancing a catheter, holding an implant in a torsion state, to the target location, wherein a proximal portion of the catheter engages a first end portion of the implant, a distal portion of the catheter engages a second end portion of the implant, and the implant applies a torque to the catheter, the catheter having a helical kerf defining opposing sides along a helical coil; and disengaging the first end portion from the proximal portion and/or the second end portion from the distal portion, such that the implant achieves a relaxed state.
Clause 227. The method of Clause 226, wherein the kerf has a non-linear profile following a helical path.
Clause 228. The method of any of Clauses 226-227, wherein the torque causes the opposing sides of adjacent windings of the coil between the proximal portion and the distal portion to be pulled toward each other.
Clause 229. A method of assembling an implant delivery system, comprising: providing an implant, in a relaxed state, to a catheter having a kerf extending in a first helical direction and defining opposing sides along a helical coil; engaging a first end portion of the implant with a proximal portion of the catheter; and engaging a second end portion of the implant with a distal portion of the catheter, such that the implant is held in a torsion state by the catheter, and such that the implant applies a torque to the catheter.
Clause 230. The method of Clause 229, wherein the kerf has a non-linear profile following a helical path.
Clause 231. The method of any of Clauses 229-230, wherein the torque causes the opposing sides of adjacent windings of the coil between the proximal portion and the distal portion to be pulled toward each other.
Clause 232. The assembly of any of Clauses 229-231, wherein the implant further comprises a helical member extending in a second helical direction, opposite the first helical direction.
Clause 233. An assembly for delivering an implant to a target location within a body lumen, comprising: a catheter comprising a proximal portion, a distal portion, and a plurality of filaments extending in a first helical direction and connecting the proximal portion to the distal portion; and an implant comprising a first end portion, a second end portion, a torsion state, and a relaxed state, wherein the implant is biased to the relaxed state and wherein, while the implant is in the torsion state, the proximal portion engages the first end portion, the distal portion engages the second end portion, and the implant applies a torque to the catheter.
Clause 234. The assembly of Clause 233, wherein the implant further comprises a helical member extending in a second helical direction, opposite the first helical direction.
Clause 235. The assembly of any of Clauses 233-234, wherein, while the implant is in the torsion state, adjacent pairs of the plurality of filaments are configured to contact each other.
Clause 236. The assembly of any of Clauses 233-235, wherein, while the implant is in the relaxed state, adjacent pairs of the plurality of filaments are configured to be separated from each other.
Clause 237. The assembly of any of Clauses 233-236, wherein, while the implant is in the relaxed state, the proximal portion is configured to disengage from the first end portion and/or the distal portion is configured to disengage from the second end portion.
Clause 238. The assembly of any of Clauses 233-237, wherein, while in the torsion state, the implant is configured to have a number of turns greater than a number of turns of the implant while in the relaxed state.
Clause 239. The assembly of any of Clauses 233-238, wherein, while in the torsion state, the implant is configured to have an outer diameter smaller than an outer diameter of the implant while than in the relaxed state.
Clause 240. The assembly of any of Clauses 233-239, wherein, while in the torsion state, the implant is configured to have a longitudinal length longer than a longitudinal length of the implant while in the relaxed state.
Clause 241. The assembly of any of Clauses 233-240, wherein the middle portion is configured to flex by separating the plurality of filaments on a side of the middle section.
Clause 242. A method of delivering an implantable device to a target location in a body lumen, comprising: advancing a catheter, holding an implant in a torsion state, to the target location, wherein a proximal portion of the catheter engages a first end portion of the implant, a distal portion of the catheter engages a second end portion of the implant, and the implant applies a torque to the catheter, the catheter having a helical kerf defining opposing sides along a helical coil; and disengaging the first end portion from the proximal portion and/or the second end portion from the distal portion, such that the implant achieves a relaxed state.
Clause 243. The method of Clause 242, wherein the torque causes a plurality of filaments extending in a first helical direction and connecting the proximal portion to the distal portion to be pulled toward each other.
Clause 244. A method of assembling an implant delivery system, comprising: providing an implant, in a relaxed state, to a catheter having a plurality of filaments extending in a first helical direction; engaging a first end portion of the implant with a proximal portion of the catheter; and engaging a second end portion of the implant with a distal portion of the catheter, such that the implant is held in a torsion state by the catheter, and such that the implant applies a torque to the catheter.
Clause 245. The method of Clause 244, wherein the torque causes the adjacent pairs of the plurality of filaments to be pulled toward each other.
Clause 246. The method of any of Clauses 244-245, wherein the implant further comprises a helical member extending in a second helical direction, opposite the first helical direction.
Clause 247. An expandable device comprising any of the features recited in any of the preceding clauses or herein.
Clause 248. A method of delivering an expandable device comprising any of the features recited in any of the preceding clauses or herein.
Additional features and advantages of the subject technology will be set forth in the description below, and in part will be apparent from the description, or may be learned by practice of the subject technology. The advantages of the subject technology will be realized and attained by the structure particularly pointed out in the written description and embodiments hereof as well as the appended drawings.
It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory and are intended to provide further explanation of the subject technology.
The accompanying drawings, which are included to provide further understanding of the subject technology and are incorporated in and constitute a part of this specification, illustrate aspects of the subject technology and together with the description serve to explain the principles of the subject technology.
In the following detailed description, numerous specific details are set forth to provide a full understanding of the subject technology. It should be understood that the subject technology may be practiced without some of these specific details. In other instances, well-known structures and techniques have not been shown in detail so as not to obscure the subject technology.
While the present description sets forth specific details of various embodiments, it will be appreciated that the description is illustrative only and should not be construed in any way as limiting. It is contemplated that although particular embodiments of the present inventions may be disclosed or shown in particular contexts, such embodiments can be used in a variety of endoluminal applications. Various applications of such embodiments and modifications thereto, which may occur to those who are skilled in the art, are also encompassed by the general concepts described herein.
The present disclosure provides various embodiments of an expandable device, such as a stent, and a catheter for supporting and delivering the stent, as well as methods of using the devices and catheters.
According to some embodiments, devices, catheters, systems, and methods disclosed herein can be used for percutaneous, peripheral occlusion of the arterial and venous vasculature. For example, some embodiments can be used to treat pelvic venous incompetence, varicocele, gonadal vein for pelvic varices in females with chronic pelvic pain, stop blood loss from a damaged blood vessel due to a traumatic arterial injury, stop hemorrhage caused by a neoplasia, and close an abnormal blood vessel or blood vessels supplying a vascular anomaly such as arteriovenous malformations or arteriovenous fistulas, and other conditions.
According to some embodiments, devices, catheters, systems, and methods disclosed herein can also be used for percutaneous, peripheral stenting of the arterial and venous vasculature.
According to some embodiments, an assembly can be provided including an expandable device and a catheter, which can be configured to engage, support, and/or house the device for delivery to a treatment location. The device can be engaged, supported, and/or housed along a distal portion of the device. Some embodiments can advantageously provide an assembly that has a cross-sectional profile that is much less than existing medical implant delivery assemblies.
For example, the catheter can define an outer diameter from about 2 Fr to about 12 Fr, as noted in Table 1 below and discussed further herein. These dimensions are provided for illustrative purposes only, and the sizes of the components disclosed herein can vary from those sizes listed below.
According to some embodiments, the reduced diameter or reduced cross-sectional profile can be achieved by using stent or frame structures that can have a nominal profile that is less than about five times the cross-sectional profile of the filament(s) or wire forming the stent or frame structure. For example, in some embodiments, the stent or frame structure can be formed using a single elongate wire that is drawn into a generally linear configuration and moved through a catheter lumen toward the target site. Some embodiments can comprise two or more elongate wires that can be drawn into generally elongate linear configurations. Accordingly, various embodiments can be provided in which the elongate wires are drawn into a minimum profile configuration that allows the stent to assume a collapsed configuration having a cross-sectional profile that allows the stent to be loaded and delivered using a very small gauge catheter.
In accordance with some embodiments, a medical implant can be provided that can be used in a variety of clinical applications, such as vessel occlusion, stenting, or other functions within a body vessel. The medical implant can comprise a frame and one or more secondary components.
As noted, in some embodiments, the implant can at least partially occlude or block flow in a body lumen, such as a blood vessel. Some embodiments can be configured to provide complete and immediate occlusion of target lumen. Further, some embodiments can be configured to prevent or reduce any tendency for migration of the deployed device under pulsatile blood pressure. Furthermore, some embodiments can be configured to facilitate precise and well controlled deployment of the device for structure with movement of the device in and out of the catheter up until the moment of final detachment.
The frame can comprise one or more resilient members, such as wires, which can be drawn out into a delivery configuration in which the frame is in a generally linear configuration and thereafter expand to an expanded state when released from a delivery device, such as a catheter.
Various embodiments of the frame can be comprise one or more features, such as having a variable pitch, an alternating pitch, a laminated configuration, a consistent pitch, upright configuration, a dual wire loop configuration, axial backbones interconnecting support elements, radial expandable arms, and/or other features disclosed herein. Further, embodiments of the frame can be used with occlusive structures, valves, occlusive covers, fibrous membranes, and the like.
Further, in accordance with some embodiments, the implants and delivery systems can be used in combination with image-guided placement techniques, such as fluoroscopy and the like.
Similarly,
In some embodiments, the catheter 110, 210 can define a length from about 50 cm to about 200 cm, from about 70 cm to about 160 cm, or in some embodiments, about 120 cm, with a working length of from about 85 cm to about 140 cm, from about 95 cm to about 130 cm. In accordance with some embodiments, the total length of the implant carrier assembly (with handle) can be about 117 cm, with a working length of 97 cm.
The catheter 110, 210 can be configured to move within a guide sheath when advancing the assembly 100, 200 into a patient for treatment. The proximal portion 112, 212 of the catheter 110, 210 can be configured to be relatively stiff in order to enhance the pushability of the catheter 110, 210 through the guide sheath. Further, the distal portion 114, 214 can be relatively flexible in order to improve the maneuverability and trackability of the catheter 110, 210 as it is advanced through the guide sheath.
The assembly 100, 200 can also comprise an implant or device 120, 220. As shown in
Further, the assembly 100 can also comprise a deployment handle assembly 150 attached to the catheter proximal portion 112. The deployment handle assembly 150 shown in
For example, the deployment handle 150 can be configured to provide separate, dedicated pull members 152, 154 for releasing each of the distal and proximal portions of the implant 120. The pull member 152 can be coupled to a first elongate member, and the pull member 154 can be coupled to a second elongate member. The first and second elongate members can extend distally toward the engagement section 116. The first and second elongate members can be releasably engageable with respective proximal or distal portion of the implant 120. In use, the pull member 154 can be proximally withdrawn, causing the second elongate member to move proximally and disengage with the proximal or distal end of the implant 120. Further, the pull member 152 can then be proximally withdrawn, causing the first elongate member to move proximally and disengage with the other of the proximal or distal end of the implant 120. The assembly 100 can thereby provide either sequential or simultaneous controlled deployment of the proximal and distal ends of the implant 120.
Additionally, the deployment handle 230 uses a single pull member 232 that can be, for example, moved a first distance to release the distal portion of the implant 220 and pulled a second distance to release the proximal portion of the implant 220. The pull member 232 can be coupled to an elongate member that extends distally toward the engagement section 216. The elongate member can be releasably engageable with proximal and distal portion of the implant 220. In use, the pull member 232 can be proximally withdrawn at a first axial distance, causing the elongate member to move proximally and disengage with the proximal or distal end of the implant 220. Further, the pull member 232 can then be proximally withdrawn a second axial distance, greater than the first axial distance, causing the first elongate member to move proximally and disengage with the other of the proximal or distal end of the implant 120. The assembly 100 can thereby provide either sequential or simultaneous controlled deployment of the proximal and distal ends of the implant 120.
Further, in some embodiments, whether a single or multiple pull members are used, the pull members can be pushed distally relative to the handle assembly 150, 230 to cause release of a portion of the implant from engagement with the assembly 100, 200. Thus, the pull members can move in either direct, and in any order, to release one or more portions of the implant (e.g., the distal or proximal ends of the implant), whether sequentially or simultaneously.
The implant carrier assemblies 100, 200 may be used in combination with any of the implants disclosed herein, including variations and combinations thereof.
For example, referring now to
Referring now to
As shown in
The catheter 210 can comprise a proximal aperture 600 and a distal aperture 602. The proximal and distal aperture 600, 602 are configured to extend through the wall 402 of the catheter 210 as slots or notches that extend transversely relative to a longitudinal axis of the catheter lumen 400. Each of the proximal or distal sections 310, 312 of the support frame 302 extends within the respective proximal or distal aperture 600, 602 of the catheter 210. As shown in
Accordingly, some embodiments can be configured such that the proximal and/or distal sections 310, 312 can be constrained against movement in an axial direction 646, a radial direction 648, and a transverse direction 650. Thus, when the support frame 302 is coiled about the engagement section 216 of the catheter 210, the proximal and distal sections 310, 312 of the support frame 302 can be secured in various directions to be engaged during delivery of the support frame 302 to the treatment site. When the support frame 302 reaches the treatment site, the support frame 302 can then be released and expanded.
As shown in
The support frame 302 is mounted, collapsed, or wound around the catheter distal portion. Before the support frame 302 is released, the support frame 302 is helically wound tightly around the catheter 210. The winding of the support frame 302 about the catheter distal portion can put the support frame 302 into a stressed state. As discussed further below, the support frame 302 will tend to rebound or expand from the stressed, mounted, collapsed, or wound position.
An initial phase of the implant expansion is illustrated in
In some embodiments, a length of support frame 302 may be between about 7 millimeters (mm) and about 9 mm. In some embodiments, the length of support frame 302 may be less than about 7 mm or greater than about 9 mm. In some embodiments, the length of distal portion may be less than about 3 mm or greater than about 4 mm. In some embodiments, a diameter of the proximal portion and/or the middle portion may be between about 2 mm and about 10 mm. In some embodiments, the diameter of the proximal portion and/or the middle portion may be less than about 2 mm or greater than about 10 mm.
In some embodiments, radio-opaque markers may be located on support frame 302 or occlusion membrane 304 for endovascular or other image-guided procedures. For example, a radio-opaque marker may be placed on a first coil of support frame 302. In some embodiments, an outer cross sectional dimension of the first coil is less than an outer cross sectional dimension of a second coil of support frame 302, which will allow space for the radio-opaque marker to surround, at least in part, an exterior of the first coil. In some embodiments, the first coil is adjacent to the second coil, and occlusion membrane 304 may be coupled to the second coil. In this regard, having the radio-opaque marker placed on the first coil adjacent to the second coil that is coupled to occlusion membrane 304 will allow an operator to identify where embolization may occur, for example. In some embodiments, the radio-opaque marker may be a platinum iridium alloy or other suitable markers known to those of ordinary skill in the art.
According to various embodiments of the subject technology, occlusion membrane 304 may be used to occlude, partially or completely, luminal structure in which an implant is deployed. In some embodiments as used herein, occlusion may refer to either partial or complete occlusion.
Some embodiments can also comprise a frame having a laminated configuration. The laminated configuration can be achieved using two or more interconnected frame components that overlay each other in either a radial or longitudinal direction.
For example, as illustrated below in
The first and second helical member 620, 622 can contact each other at opposing surfaces along the length of the frame 610. Accordingly, the second helical member 622 may have an outer diameter equal to the inner diameter of the first helical member 620. Alternatively, the first and second helical member 620, 622 can face each other with opposing surfaces separated by a helical gap. Accordingly, the second helical member 622 may have an outer diameter smaller than the inner diameter of the first helical member 620.
The first and second helical members 620, 622 can be connected at one or more of their ends 602, 604 or at one or more positions along the length of the frame 610 by coupling members 630. The coupling members 630 may be wires, ties, cuffs, coils, rings, adhesion, welding, and/or other connection mechanisms, which can be radiopaque, such as cuffs, coils, or bands used to maintain relative positioning of the first and second helical members 620, 622. The coils, cuffs, or bands used to connect coils may be constructed of a radiopaque material such as gold, platinum, tungsten, or plastic impregnated with a radiopaque material.
According to some embodiments, a laminated frame 610 configuration can enable smaller delivery diameters with the utilization of thinner wire, but maintain radial force applied against vessel wall after deployment to secure location of implant. The frame 610 may have consistent pitch, alternating pitch, or have variable pitch intended to improve stability after deployment. Alternate design options can include a tapered diameter, or varying diameter constructs, as disclosed herein.
Although according to some embodiments, the first and second helical members 620, 622 can have a wire shape that is rectangular in cross section, the wire shape can also be oval shaped, diamond shaped, etc., having an axial width that is greater than a radial thickness.
In accordance with some embodiments, as shown in
In accordance with some embodiments, an implant can comprise an upright frame in a coiled configuration. In such embodiments, a frame can be formed by a coiled wire having a cross-section with a radial thickness that is greater than its longitudinal or axial width. For example, the frame can comprise a flat coil that extends in a helical direction and has cross-section having a radial thickness that is greater than its axial or longitudinal width.
For example, as illustrated below in
The upright frame 710 may have consistent pitch, alternating pitch, or have variable pitch intended to improve stability after deployment. Alternate design options can include a tapered diameter, or varying diameter constructs, as disclosed herein.
According to some embodiments, the cross section of the frame 710 can have a radial thickness that is between about 1.5 to about 10 times as great as the axial width of the frame. Further, in some embodiments, the cross section of the frame can have a radial thickness that is between about 2 to about 8 times as great as the axial width of the frame. Additionally, in some embodiments, the cross section of the frame can have a radial thickness that is between about 2.5 to about 6 times as great as the axial width of the frame. Furthermore, in some embodiments, the cross section of the frame can have a radial thickness that is between about 3 to about 4 times as great as the axial width of the frame.
Although according to some embodiments, the upright frame 710 can have a wire shape that is rectangular in cross section, the wire shape can also be oval shaped, diamond shaped, etc., having a radial thickness that is greater than an axial width.
According to an aspect of some embodiments, the upright frame 710 can be configured to assume a generally linear state during delivery. Alternatively, the upright frame 710 can be configured to assume a compressed state during delivery, wherein, while in the compressed state the frame 710 has a cross-sectional dimension less than in an expanded state. For example, the upright frame 710 can be held straight or in a tight coil during delivery to target location and as the frame is moved out of the delivery device (such as a catheter), the frame 710 can expand to a coiled, expanded state, as illustrated in
The upright frame 710 can be delivered from a delivery device 790 out of a distal aperture (not shown) of a lumen 794 of the delivery device 790. However, as illustrated in
In accordance with some embodiments, as shown in
As shown in
The cover 750 may extend over a full or partial length of the frame 710. The cover 750 may reside outside, inside, or a combination of inside and outside of the frame 710. As shown in
While various embodiments disclosed herein relate to “coil-type” implant support frames, defined a support frames that extend helically only in a single direction, some embodiments disclosed herein can comprise a “non-coil-type” implant support frames, defined as support frames that have do not extend helically in only a single direction (i.e., that reverse direction one or more times), implant support frames that have symmetrical halves that each extend about only a portion of a perimeter of the support frame and are coupled to each other to form a completed support frame, or support frames that do not extend helically at all.
For example, a non-coil-type support frame, such as a symmetrical dual-component implant support frame, can have symmetrical halves formed using dual wires that each extend about only a portion of a perimeter of the support frame and are coupled to each other to form a completed support frame. Such embodiments can provide various advantages over coil-type support frames. Generally, the maximum expanded diameter to which a coil-type support frame can resiliently expand is less than the maximum expanded diameter to which a non-coil-type or symmetrical support frame can resiliently expand. Further, the minimum collapsed diameter or profile of a coil-type support frame is greater than the minimum collapsed diameter or profile of a non-coil-type or symmetrical support frame.
Thus, a non-coil-type or symmetrical support frame can be delivered through a lower profile catheter and/or be released into vessels having a larger diameter than those treatable by a coil-type support frame. Further, even if a coil-type support frame is designed to provide the same minimum collapsed profile as a non-coil-type or symmetrical support frame, the non-coil-type or symmetrical support frame can have a greater maximum expanded diameter than the coil-type support frame. Furthermore, even if a coil-type support frame is designed to provide the same maximum expanded diameter as a non-coil-type or symmetrical support frame, the non-coil-type or symmetrical support frame can have a smaller minimum collapsed profile than a coil-type support frame.
In addition, because a non-coil-type or symmetrical support frame need not be torsionally constrained when mounted or supported on a support member (e.g., a catheter), the non-coil-type or symmetrical support frame will not tend to exert any torsional force or torque on the support member. Thus, the support member carrying a non-coil-type or symmetrical support frame need not provide any significant torque resistance to accommodate torque exerted by the non-coil-type or symmetrical support frame (which would otherwise be necessary if a coil-type support frame were used).
Some embodiments of a non-coil-type or symmetrical support frame are illustrated in
Similar to some of the embodiments disclosed herein, the support member 802 can comprise one or more lumens and be configured to be delivered over the wire (“OTW”) to the target or treatment site.
The wires 830, 832 may be coupled together and extend axially along axial portions 840a and 840b. The axial portions 840a may be radially opposite the axial portions 840b across the central axis 836. Along the axial portions 840a, 840b, the wires 830, 832 may be adjacent and/or contacting. The wires 830, 832 may be joined or coupled together with connectors 842a at the axial portions 840a and with connectors 842b at the axial portions 840b. As shown in
The wires 830, 832 may extend circumferentially along circumferential portions 850a and 850b. The circumferential portions 850a may be radially opposite the circumferential portions 850b across or about the central axis 836. Each of the circumferential portions 850a, 850b may extend from an axial portion 840a to an axial portion 840b, radially opposite the axial portion 840a. The circumferential portions 850a, 850b can collectively define one or more rings or support elements 852, as illustrated in
Thus, the interconnections of the separate wires 830, 832 can lie substantially in a common plane. However, the separate wires 830, 832 can also form interconnections that are not mirror images or that do not lie in a common plane. For example, in some embodiments in which the frame 810 defines a generally tubular shape, the interconnections can be located at different and varied circumferential locations. For example, the interconnections can be distributed across one, two, three, four, five, or more circumferential locations. The pattern can be a repeating pattern or randomized, which can provide a desired flexibility or strength characteristics for the frame.
Additionally, the separate wires 830, 832 can be of a common gauge or can have different gauges, in order to impart a desired strength characteristics.
The support elements 852 of the support frame 810 can be generally circular. However, the support elements 852 can be formed in any of a variety of shapes, including square, triangle, rectangle, oval, or other polygons (having five, six, seven, eight, nine, or more sides). Additionally, as illustrated in
For example, the support elements 852 can have expanded diameters from about 2 mm to about 30 mm or more. In some embodiments, the expanded diameter of a given support element 852 can be between about 2 mm and about 20 mm, between about 3 mm and about 16 mm, between about 4 mm and about 12 mm, or between about 5 mm and about 8 mm. For example, a given support element 852 can have an expanded diameter of about 2 mm, 3 mm, 4 mm, 5 mm, 6 mm, 7 mm, 8 mm, 9 mm, 10 mm, 11 mm, 12 mm, 13 mm, 14 mm, 15 mm, 16 mm, 17 mm, 18 mm, 19 mm, 20 mm, 21 mm, 22 mm, 23 mm, 24 mm, 25 mm, 26 mm, 27 mm, 28 mm, 29 mm, 30 mm, or more.
In some embodiments, each of the support elements 852 can have an expanded diameter that is different from the other support elements 852 of the frame 810.
For example, as shown in
According to some embodiments, the variation of expanded diameter sizes of the support elements 852 can allow the implant 802 self-adjust to different vessel diameters and/or provide anti-migration benefits. In accordance with some embodiments, the support frame 810 illustrated in
For example, when the embodiment of
Such embodiments can advantageously permit the implant to be used with a range of vessel sizes.
Further, as similarly noted above, the implant 800 can advantageously be used in a greater range of vessel diameters than coil-type implant support frames that extend helically in a single direction. For example, some embodiments, such as that illustrated in
For example, with some non-coil-type embodiments, such as the implant 800, the ratio of the minimum collapsed profile to the maximum expanded profile (which can be measured in a diameter that circumscribes the collapsed or expanded profile) can be between about 1:20, about 1:18, about 1:16, about 1:15, about 1:14, about 1:13, about 1:12, about 1:11, about 1:10, about 1:9, about 1:8, about 1:7, about 1:6, about 1:5, about 1:4, about 1:3, or about 1:2.
Additionally, due to the exceptional minimum collapsed profile achievable using some non-coil-type embodiments, such as the implant 800, the implant 800 can be fitted into a delivery catheter having a profile of less than about 5 Fr, less than about 4 Fr, less than about 3 Fr, or smaller.
In accordance with some embodiments, the support frame 810 can also be formed using a plurality of support elements 852 that are interconnected with one or more backbone members or axial portions. The backbone members can extend in a longitudinal or axial direction such that the support elements 852 are spaced apart along the longitudinal axis of the support frame 810. Thus, instead of having a pair of wires 830, 832, the support frame 810 can be formed using a series of same-sized or differently sized rings or support elements 852 that are interconnected to each other using backbone members that are welded or otherwise coupled to the adjacent rings to form a cylindrical structure that has a constant diameter (in the case of using support elements that have a common diameter) or a cylindrical structure that has a varying diameter (in the case of using support elements that have different diameters, as in
The backbone member(s) can extend intermittently on opposing sides of the support elements 852 as shown in
As also illustrated in
For example,
As illustrated, the protrusions 882, 886 can comprise a notch into which a corresponding protrusion of the proximal and distal coupling members 870, 872 can be fitted in order to restrict longitudinal or axial movement of the coupling members 870, 872 relative to the proximal and distal engagement mechanisms 880, 884. Accordingly, when engaged, the support frame can be drawn or stretched along the implant support section 822 of the support member 802.
In some embodiments, the protrusions 882, 886 of the proximal and distal engagement mechanisms 880, 884 can be formed on the support member 802. For example, the protrusions 882, 886 can be formed as radial notches in the support member 802 or as depressions in an outer surface of the support member 802. The proximal and distal engagement mechanisms 880, 884 also be attached or coupled to the support member 802, such as by welding or adhesive means.
Furthermore, in some embodiments, as shown in
Although in some embodiments, the proximal and distal engagement mechanisms 880, 884 can remain at a fixed longitudinal position relative to the support member 802, the proximal and distal engagement mechanisms 880, 884 can also be moved relative to the support member 802 in order to facilitate engagement or disengagement of the support frame 810 to or from the proximal and distal engagement mechanisms 880, 884.
The proximal and distal coupling members 870, 872 can be releasably engaged by the protrusions 882, 886. In some embodiments, the engagement can be substantially only a mechanical engagement, while in other embodiments, release of the engagement can be actuated by overcoming an adhesive. Further, the proximal and distal coupling members 870, 872 can be continuous with the protrusions 882, 886, such that an electrolytic detachment mechanism can be used to break the connection between the support member 802 and the support frame 810.
Further, in some embodiments, the distal coupling member 872 can be releasably engaged with the protrusion 886 to form a locking mechanism that is engaged only when the distal coupling member 872 and the protrusion 886 are disposed within a lumen of a catheter 890, as illustrated in
Additionally, in some embodiments, the proximal and distal ends of the implant 800 can be engaged using the engagement mechanisms illustrated in discussed with regard to
However, when the distal engagement mechanism 884 exits the lumen 892, the distal coupling member 872 will radially shift and expand to disengage from the distal engagement mechanism 884, thus permitting a distal end of the support frame 810 to begin to expand within the vessel. This process is illustrated in
Additionally, in embodiments using a mechanical locking mechanism, in order to assemble the support frame 810 with the support member 802, the support member 802 can be positioned within a guide catheter 890 such that the support section 822 of the support member 802 is positioned distally beyond a distal end of the guide catheter 890. In this position, the proximal engagement mechanism 880 can be engaged with the proximal coupling member 870 and the support member 802 can then be drawn proximally into the lumen 892 of the catheter 890, thereby radially constrained the proximal engagement mechanism 880 with the proximal coupling member 870, which also longitudinally constrains relative movement of the proximal engagement mechanism 880 relative to the proximal coupling member 870. When completed, the support member 802 can be further proximally withdrawn into and relative to the catheter 890 until the distal engagement mechanism 884 and the distal coupling member 872 are positioned adjacent to a distal end of the catheter 890. At that point, the distal engagement mechanism 884 and the distal coupling member 872 can be aligned or engaged with each other and the support member 802 can be further proximally withdrawn into and relative to the catheter 890 until the distal engagement mechanism 884 is fully received within the lumen 892 of the catheter 890. Thereafter, the assembly can be used.
Furthermore, the membrane 812 can be positioned on top of the support member 802 prior to placing the support frame 810 onto the support member 802 or drawn or pulled under the support frame 810 all the support frame is initially engaged or fitted over the support member 802, in a manner similar to that disclosed in co-pending U.S. patent application Ser. No. 14/044,794, filed on Oct. 2, 2013, the entirety of which is Incorporated herein by reference.
Once in position, the catheter 890 and the support member 802 can be moved relative to each other such that the support member 802 begins to exit the distal end of the catheter 890, thereby allowing the distal engagement mechanism 884 to disengage from the distal coupling member 872. Once this occurs, the distal end of the implant 800 begins to expand, as illustrated in
Thereafter, as the catheter 890 continues to be withdrawn or proximally, the implant 800 continues to expand and contact the wall of the vessel 809. As this occurs, the support elements 852 urge the membrane 812 into contact with the vessel wall.
Should the placement of the implant 800 be undesirable, prior to releasing a proximal end of the implant 800, the implant 800 can be proximally withdrawn into the catheter 890 by urging the catheter 890 distally over the implant 800, thereby causing the implant 800 to be radially collapsed and pulled into or within the catheter 890. Thereafter, the implant 800 can be repositioned and a distal end of the implant 800 can be re-released. Once the positioning of the implant 800 is verified, the proximal end of the implant 800 can be released from the assembly 808.
As shown in
As shown in
In accordance with some embodiments, the implant 800 can also comprise a valve mechanism that permits the guide wire 824 to be passed therethrough while the assembly 808 is advanced to the target region. However, in some implementations, the guide wire a toy four can be removed after the assembly 808 reaches the target region. Thereafter, the valve mechanism of the implant 800 can allow the distal end of the implant 800 to close and occlude flow when the implant 800 is released into the vessel 809. Further, the implant 800 can be used with a valve or cover component in a manner suitable for deploying an embolic material to a target region, such as for cancer therapy, as disclosed in copending U.S. patent application Ser. No. 14/101,171, filed Dec. 9, 2013, the entirety of which is incorporated herein by reference.
In accordance with some embodiments, a medical implant 900 can form a frame including one or more dual wire loop features. A dual wire loop feature can be formed by using one or more individual wires that are shaped to form a partial coil For example, two separate wires 910, 912 can be configured to have opposite (clockwise and counterclockwise) directions of winding, and the separate wires 910, 912 can be connected to form full loops.
In some embodiments, the separate wires 910, 912 can be generally mirror images of each other along a longitudinal center plane (extending through the central axis 940) of the frame 900, as illustrated in
The wires 910, 912 may extend axially along axial portions 920a and 920b. The axial portions 920a may be radially opposite the axial portions 920b across the central axis 940. Along the axial portions 920a, 920b, the wires 910, 912 may be adjacent and/or contacting. The wires 910, 912 may be joined or coupled together with connectors 930a at the axial portions 920a and with connectors 930b at the axial portions 920b. As shown in
The wires 910, 912 may extend circumferentially along circumferential portions 922a and 922b. The circumferential portions 922a may be radially opposite the circumferential portions 922b across or about the central axis 940. Each of the circumferential portions 922a, 922b may extend from an axial portion 920a to an axial portion 920b, radially opposite the axial portion 920a. The axial portions 920a, 920b between which a single circumferential portion 922a or 922b extends may be axially displaced relative to each other. Each wire 910, 912 may extend entirely on a respective radial side of the frame 900. Each circumferential portion 922a or 922b may extend along at least a portion of a cylindrical path in a clockwise circumferential direction toward a given axial portion 920a or 920b, and each circumferential portion 922a or 922b may extend along at least a portion of the cylindrical path in a counterclockwise circumferential direction away from the given axial portion 920a or 920b. Each wire 910, 912 may contact all or less than all of the connectors 930a, 930b.
Thus, the interconnections of the separate wires 910, 912 can lie substantially in a common plane. However, the separate wires 910, 912 can also form interconnections that are not mirror images or that do not lie in a common plane. For example, in embodiments in which the frame 900 defines a generally tubular shape, the interconnections can be located at different and varied circumferential locations. For example, the interconnections can be distributed across one, two, three, four, five, or more circumferential locations. The pattern can be a repeating pattern or randomized, which can provide a desired flexibility or strength characteristics for the frame.
Additionally, the separate wires 910, 912 can be of a common gauge or can have different gauges, in order to impart a desired strength characteristics.
Additionally, as illustrated above and in
In accordance with some embodiments, the medical implant can comprise a frame 1010 that incorporates a fibrous membrane feature. The fibrous membrane feature can be implemented using one or more filaments 1030 and/or membranes 1060 that extend between one or more engagement members of the frame 1010. The fibrous membrane 1060 can be porous or comprise one or more portions that are nonporous, such as impermeable occlusive structures or other such sections. The engagement members can be configured as holes, apertures, slits, protrusions, cavities, adhesive connections, or other features that allow interconnection with one or more filaments.
In accordance with some embodiments,
For example, the frame 1010 can comprise a fibrous membrane 1060 having one or more filaments 1030 that are interconnected between apertures or holes 1020 in the frame 1010. In accordance with some embodiments, a flat coil frame 1010 can be provided that comprises a plurality of holes 1020 extending along the length of the frame 1010. The plurality of holes 1020 can be used to interconnect with a plurality of fibers 1030 or aspects of a membrane 1060 or cover, as illustrated in
From a hole 1020a, a filament 1030 may extend to another hole 1020b. The holes 1020a, 1020b may be axially displaced relative to each other. For example, the holes 1020a, 1020b may be disposed on separate helical turns 1050a and 1050b of the frame 1010. The separate turns 1050a, 1050b may be axially adjacent or separated by yet other helical turns of the frame 1010. As shown in
The holes 1020a, 1020b may have a common circumferential location, regardless of axial location. For example, the filament 1030 may extend axially between the holes 1020a, 1020b in a direction that is parallel to the central axis 1040. Alternatively, the holes 1020a, 1020b may have different circumferential locations. Accordingly, the filament 1030 may extend helically or non-axially between the holes 1020a, 1020b.
According to some embodiments, the fibrous membrane or patch 1060 can extend along only an axial portion of the frame 1010. For example, the fibrous membrane or patch can extend along a central axial portion, a distal axial portion, and/or a proximal axial portion of the frame 1010, which can be determined based on the application and in response to the vessel geometry. However, in some embodiments, the fibrous membrane or patch 1060 can be configured to extend along the entire axial length of the frame 1010.
In accordance with some embodiments,
Multiple filaments 1110 can be shaped in a coil or helical configuration. As shown in
The filaments 1110 may define a first (e.g., proximal) face 1122 near the first end member 1102, and a second (e.g., distal) face 1124 near the second end member 1104. One or both of the first and second faces 1122, 1124 may define a surface that is transverse (e.g., orthogonal) to the central axis 1140. Alternatively, one or both of the first and second faces 1122, 1124 may define a surface that is hemispherical, conical, frustoconical, concave, convex, combinations thereof, and the like.
In the expanded state, the filaments 1110 can define a substantially cylindrical profile in a middle region 1126 between the end members 1102, 1104, as shown in
The first end member 1102 may be axially opposite the second end member 1104 along an axis 1140. The end members 1102, 1104 may be of a radiopaque material or may include a separate component (not shown) being of a radiopaque material, for visualization during a procedure.
The filaments 1110 can extend helically between the end members 1102, 1104. The filaments 1110 can be fixed to the end members 1102, 1104 by attachment (e.g., welding). The filaments 1110 can be integrally formed with the end members 1102, 1104. For example, the filaments 1110 and the end members 1102, 1104 may all be cut from a single tube, rather than assembling from separate components.
As the implant 1100 transitions from a compressed state (as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, the implant 1100 may contain a wire 1180 through the center that can be attached to the distal end member 1104, and slides through the proximal end member 1102. The implant 1100 would be shape-set to the expanded state. The implant 1100 can be deployed by advancing the wire 1180 to push the implant 1100 out of a lumen 1194 of the catheter 1190, at which point the proximal end member 1102 would spring axially towards the distal end member 1104. The wire 1180 may then be detached and removed. Detachment of the wire 1180 may include retraction that overcomes a holding force (e.g., friction), removal of an interference fit, electrolytic detachment, thermal detachment, combinations thereof, and the like.
In accordance with some embodiments,
Multiple struts 1210 can be shaped in a configuration that is substantially linear in a compressed state (
The struts 1210 may define a first (e.g., proximal) face 1222 near the first end member 1202, and a second (e.g., distal) face 1224 near the second end member 1204. One or both of the first and second faces 1222, 1224 may define a surface that is hemispherical, conical, frustoconical, concave, convex, combinations thereof, and the like. In the expanded state, the struts 1210 can define a substantially spherical profile between the end members 1202, 1204, as shown in
The first end member 1202 may be axially opposite the second end member 1204 along the axis 1240. The end members 1202, 1204 may be of a radiopaque material or may include a separate component (not shown) being of a radiopaque material, for visualization during a procedure.
The struts 1210 can be fixed to the end members 1202, 1204 by attachment (e.g., welding). The struts 1210 can be integrally formed with the end members 1202, 1204. For example, the struts 1210 and the end members 1202, 1204 may all be cut from a single tube, rather than assembling from separate components.
As the implant 1200 transitions from a compressed state (as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, the implant 1200 may contain a wire 1244 through the center that can be attached to the distal end member 1204, and slides through the proximal end member 1202. The implant 1200 would be shape-set to the expanded state. The implant 1200 can be deployed by advancing the wire 1244 to push the implant 1200 out of a lumen 1294 of the catheter 1290, at which point the proximal end member 1202 would spring axially towards the distal end member 1204. The wire 1244 may then be detached and removed. Detachment of the wire 1244 may include retraction that overcomes a holding force (e.g., friction), removal of an interference fit, electrolytic detachment, thermal detachment, combinations thereof, and the like.
In accordance with some embodiments,
As shown in
As shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, the implant 1250 may be shape-set in the expanded state, and pulled into a lumen 1294 of a catheter 1290 to collapse to the compressed state. The catheter 1290 containing the implant 1250 may be provided to a site within a vessel 1299. As shown in
In accordance with some embodiments,
The filament 1310 may form a three-dimensional shape in the expanded state. The shape can be configured to approximate the diameter of a target vessel for occlusion thereof. As shown in
For example, the cross-sectional dimension of a turn at the first side 1322 may be less than a cross-sectional dimension of a turn at a middle section (e.g., an equator) 1326, as measured in a plane transverse to the central axis 1340. By further example, the cross-sectional dimension of a turn at the second side 1324 may be less than a cross-sectional dimension of a turn at the middle section 1326, as measured in a plane transverse to the central axis 1340. The cross-sectional dimension may increase from the first side 1322 to the middle section 1326. The cross-sectional dimension may increase from the second side 1324 to the middle section 1326. The cross-sectional dimension of a turn at the first side 1322 may be the cross-sectional dimension of a turn at the second side 1324.
For example, the section between the first side 1322 and the middle section 1326 may be hemispherical, conical, frustoconical, concave, convex, combinations thereof, and the like. By further example, the section between the second side 1324 and the middle section 1326 may be hemispherical, conical, frustoconical, concave, convex, combinations thereof, and the like. The filament 1310 in the expanded state may generally form a sphere, an ovoid, a polyhedron, another smooth or angular three-dimensional shape, combinations thereof, and the like.
In accordance with some embodiments, the filament 1310 may be heat set or otherwise biased to an expanded state, as shown in an exemplary view in
In accordance with some embodiments, as shown in
As shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments,
A control rod 1432 is provided to move axially through the hub 1410. A user at a proximal location may have access to and control over each of the control rod 1432 and the hub 1410 such that the user may move them axially relative to each other. The control rod 1432 is releasably attached to an expander 1430 at a distal end thereof. The expander 1430 includes a flange or another radial extension having a cross-sectional dimension greater than a distance between radially opposite filaments 1420 while in the compressed state. The expander 1430 is configured to move axially and separate the filaments 1420 such that they move radially outwardly when brought into contact with the expander 1430. The filaments 1420 may have notches at a location between the filaments 1420 and the hub 1410, as disclosed with respect to the implant 1250.
In accordance with some embodiments, as shown in
In the fully expanded state, the filaments 1420 may apply a force (e.g., spring force) upon the expander 1430, which may be transferred to the enlarged member 1440. A force required to pass the enlarged member 1440 past the inner protrusion 1412, at least in a distal direction, can be greater than the force of the filaments 1420 on the expander 1430. For example the shape and geometries of the enlarged member 1440 and the inner protrusion 1412 may be such that proximal movement of the enlarged member 1440 past the inner protrusion 1412 is permitted while distal movement of the enlarged member 1440 past the inner protrusion 1412 is prevented. The enlarged member 1440 and/or the inner protrusion 1412 may include or form a ratchet, a pawl, or the like. For example, the enlarged member 1440 may include a section with triangular teeth that slope in one direction (e.g., facing proximally). The inner protrusion 1412 may include a flexible pawl that rides up the slope of the teeth of the enlarged member 1440 when moved past the inner protrusion 1412. The pawl engages the backside (e.g., facing distally) of the teeth to arrest distal motion thereof beyond a certain point.
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments,
A control rod 1432 is provided to move axially through the hub 1410 and a lumen 1434 of a proximal expander 1430b. A user at a proximal location may have access to and control over each of the control rod 1432 and a delivery device 1490, such that the user may move them axially relative to each other. The control rod 1432 is releasably attached to a distal expander 1430a at a distal end of the implant 1400. The expanders 1430a, 1430b include a flange or another radial extension having a cross-sectional dimension greater than a distance between radially opposite filaments 1420a, 1420b while in the compressed state. The expanders 1430a, 1430b are configured to move axially relative to each other and separate the filaments 1420a, 1420b such that they move radially outwardly when brought into contact with the corresponding expander 1430a, 1430b.
In accordance with some embodiments, as shown in
In the fully expanded state, the filaments 1420a, 1420b may apply a force (e.g., spring force) upon the expanders 1430a, 1430b, which may be transferred to the enlarged member 1440. A force required to pass the enlarged member 1440 past the proximal expander 1430b, at least in a distal direction, can be greater than the force of the filaments 1420 on the expander 1430. For example the shape and geometries of the enlarged member 1440 and the proximal expander 1430b may be such that proximal movement of the enlarged member 1440 past the proximal expander 1430b is permitted while distal movement of the enlarged member 1440 past the proximal expander 1430b is prevented. The enlarged member 1440 and/or the proximal expander 1430b may include or form a ratchet, a pawl, or the like. For example, the enlarged member 1440 may include a section with triangular teeth that slope in one direction (e.g., facing proximally). The proximal expander 1430b may include a flexible pawl that rides up the slope of the teeth of the enlarged member 1440 when moved proximally out of the lumen 1434 and proximally past the proximal expander 1430b. The pawl engages the backside (e.g., facing distally) of the teeth to arrest distal motion thereof beyond a certain point.
In accordance with some embodiments, as shown in
In accordance with some embodiments,
Multiple arms 1520 can be shaped in a configuration that is substantially linear in a compressed state and follows an arcuate pathway in an expanded state. In the expanded state, the arms 1520 may follow a serpentine pathway. For example, as shown in
Any number of arms 1520 may be provided. For example, the implant 1500 may include three, four, five, six, seven, eight, or more arms 1520. The arms 1520 may be equally spaced circumferentially about an outer circumference of the implant 1500. Alternatively, the arms 1520 may be distributed asymmetrically about the circumference of the implant 1500.
As shown in
In accordance with some embodiments, the implant 1500 may include a cover 1550 (not shown) provided over or with the arms 1520 and/or the hub 1520. The cover 1550 may be provided to the arm 1520 collectively or individually. The cover 1550 may occlude openings between the arms 1520.
As shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
As shown in
After expansion of the first implant 1500a and before expansion of the second implant 1500b, the catheter 1590 may be advanced toward the expanded first implant 1500a. As shown in
In accordance with some embodiments, the pusher 1596 may be detachably connected to at least one of the first and second implants 1500a, 1500b. The pusher 1596 may detach by one or more of a variety of mechanisms. For example, the pusher 1596 may be frictionally engaged with a hub 1510. Other detachment mechanisms are contemplated, including removal of an interference fit, electrolytic detachment, thermal detachment, combinations thereof, and the like.
In accordance with some embodiments, as shown in
In accordance with some embodiments, as shown in
Referring now to
Referring now to
As shown in
As shown in
The distal anchor 1630 can also extend along a circumferential path by forming other repeating or non-repeating patterns, such as sinusoidal waves, square waves, triangular waves, sawtooth waves, and combinations thereof. The distal anchor 1630 can otherwise extend a given axial length from a proximal end thereof to a distal end thereof. The axial length can be sufficiently large relative to the cross-sectional diameter of the anchor portion 1630 to provide sufficient stability. For example, the axial length of the anchor portion 1630 can be at least about 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100% the cross-sectional diameter of the anchor portion 1630. By further example, the axial length of the anchor portion 1630 can be greater than the cross-sectional diameter of the anchor portion 1630.
As further shown in
In some embodiments, no connection bridge 1620 is provided, such that the proximal anchor 1610 connects directly to the distal anchor 1630.
Referring now to
In some embodiments, a length of the support frame 1602 can be between about 7 millimeters (mm) and about 9 mm. In some embodiments, the length of the support frame 1602 can be less than about 7 mm or greater than about 9 mm. In some embodiments, the length of the distal anchor 1630 can be between about 3 millimeters (mm) and about 5 mm. In some embodiments, the length of the distal anchor 1630 can be less than about 3 mm or greater than about 5 mm. In some embodiments, a diameter of the proximal anchor 1610 and/or the distal anchor 1630 can be between about 2 mm and about 10 mm. In some embodiments, the diameter of the proximal anchor 1610 and/or the distal anchor 1630 can be less than about 2 mm or greater than about 10 mm.
In some embodiments, the occlusive cover 1660 can be fixed to the frame 1602. For example, the occlusive cover 1660 can be tied, glued, sutured, adhered, or otherwise fixedly attached to the frame 1602. Alternatively, the occlusive cover 1660 can be loosely provided about a portion of the frame 1602, such that the frame 1602 maintains contact with the occlusive cover by friction via an outward radial force. The outward radial force can hold the distal anchor 1660 against the occlusive covers 1660 in a catheter or against a wall of a body vessel.
Referring now to
Referring now to
In accordance with some embodiments, as shown in
The implant 1600 can fit into a 4 F catheter or smaller and possess the ability for controlled deployment and optional retrieval back into the catheter until desired positioning and detachment is complete. The implant 1600 can provide total occlusion of a blood vessel or vascular structure within the human body. The construct is applicable to all endovascular applications, specifically neurovascular vessels of 3-6 mm diameter, and peripheral vasculature of 3-14 mm. The implant 1600 can be used for delivery via a 4 F or smaller catheter system. The construct can be formed to various diameters (3-6 mm, and 6-14 mm) for use within appropriate vessels and vascular structures.
According to various embodiments of the subject technology, the implant occlusive cover 1660 can be used to occlude, partially or completely, a body vessel in which an implant 1600 is deployed. In some embodiments as used herein, occlusion can refer to either partial or complete occlusion. Occlusion provided by the occlusive covers 1660 can limit, impede, reduce, prevent, or eliminate flow within the body vessel distal to the occlusive covers 1660.
According to some embodiments of the subject technology, an implant 1600a can include an anchor 1630a and an occlusive cover 1660a. The anchor 1630a can include features and attributes of the distal anchor 1630, including features of the distal anchor 1630 with respect to the occlusive covers 1660, as disclosed herein. The anchor 1630a can include features and attributes of other structures disclosed herein, including but not limited to any of the distal anchors disclosed herein. The anchor 1630a can be provided with neither a proximal anchor nor a connection bridge. As such, the implant 1600a can include only an anchor 1630a and an occlusive covers 1660a. The anchor 1630a can be positioned entirely within or partially within the occlusive cover 1660a.
Referring now to
In accordance with some embodiments, as shown in
Referring now to
Referring now to
Referring now to
Referring now to
In accordance with some embodiments, pairs of axially adjacent circumferential rings 1770a, 1770b, 1770c can be welded together at one or more contact points. Alternatively or in combination, pairs of axially adjacent circumferential rings 1770a, 1770b, 1770c can be interwoven with an alternating over-and-under pattern, wherein portions of a first circumferential ring lie radially over portions of a second circumferential ring, and other portions of the first circumferential ring lie radially under other portions of the second circumferential ring. Alternatively or in combination, pairs of axially adjacent circumferential rings 1770a, 1770b, 1770c can be tied, adhered, or otherwise fixedly attached to each other. Pairs of struts 1740 across pairs of axially adjacent circumferential rings 1770a, 1770b, 1770c can be circumferentially aligned or circumferentially offset relative to each other.
The distal anchor 1730 can have a collapsed configuration as shown in
In accordance with some embodiments, the distal anchor 1730 can connect via a connection bridge 1720 to a proximal anchor and include other features of the frame 1602 of the implant 1600. Accordingly, the distal anchor 1730 can be delivered to within a body vessel by a method substantially similar to the method illustrated in
Referring now to
The distal anchor 1830 can have a collapsed configuration as shown in
In accordance with some embodiments, the distal anchor 1830 can connect via one or more of the connection bridges 1820a, 1820b to a proximal anchor and include other features of the frame 1602 of the implant 1600. Accordingly, the distal anchor 1830 can be delivered to within a body vessel by a method substantially similar to the method illustrated in
Referring now to
The distal anchor 1930 can have a collapsed configuration substantially similar to the configuration of the distal anchor 1630 shown in
Referring now to
The distal anchor 2030 can have a collapsed configuration substantially similar to the configuration of the distal anchor 1630 shown in
Referring now to
As shown in
As further shown in
In accordance with some embodiments, the spherical member 2130 can be constructed by a plurality of interwoven strands. For example, the spherical member 2130 can be a braided structure. The strands can extend from a proximal end member 2132 to a distal end member 2134 at opposite axial ends of the spherical member 2130. Alternatively or in combination, the spherical number 2130 can be constructed by a plurality of non-intersecting struts that extend from the proximal end member 2132 to the distal end member 2134. For example, the struts can extend axially or helically in a single direction. In accordance with some embodiments, the spherical member 2130 can be an inflatable balloon that is expandable by insufficient of a fluid. In accordance with some embodiments, the spherical member 2130 can be a swellable material that expands to form a sphere upon absorption of fluid.
In accordance with some embodiments, at least a portion of the spherical member 2130 occludes a passageway of the body vessel. For example, one or both of a proximally directed face of the spherical member 2130 and a distally directed face of the spherical member 2130 can form an occlusive surface. By further example, the structure of the spherical member 2130 (e.g., strands, struts, etc.) can partially or entirely include the body vessel. Alternatively or in combination, the spherical member 2130 can support an occlusive cover (not shown). The spherical member 2130 can be designed to be secured at a target location and hold the occlusive cover against a wall of the body vessel.
Referring now to
Referring now to
In accordance with some embodiments, as shown in
Some embodiments of the procedures, techniques, and implants disclosed herein can enable a clinician, in one or a several clinical procedures, to dynamically control the flow through a flow regulating implant. For example, according to some embodiments disclosed herein, procedures, techniques, and implants are provided by which a clinician can control or selectively adjust the flow through a shunt in order to optimize the pressure gradient between adjacent vessels, such as in the TIPS procedure or the distal splenorenal shunt procedure (DSRS) (i.e., splenorenal shunt procedure or Warren shunt). Further, methods and implants are provided in which a clinician can deposit embolic material into a target area downstream of an implanted shunt while preventing upstream flow or backflow of the particles away from the target area.
Some embodiments of the flow regulating implant can be configured to comprise a generally tubular member having a frame. In some embodiments, the tubular member can further comprise a graft, cover, or other material attached to the frame. Aspects of implants, catheters, and delivery devices that can be utilized in combination with the implants, systems, methods, and features disclosed herein are disclosed in: U.S. patent application Ser. No. 12/826,593, filed on Jun. 29, 2010 (086538-0012); U.S. patent application Ser. No. 13/367,338, filed on Feb. 6, 2012 (086538-0018); U.S. patent application Ser. No. 12/906,993, filed on Oct. 18, 2010 (086538-0014); U.S. patent application Ser. No. 13/828,974, filed on Mar. 14, 2013 (086538-0030); U.S. Patent Application No. 61/836,061, filed on Jun. 17, 2013 (086538-0038); U.S. patent application Ser. No. 14/044,794, filed on Oct. 2, 2013 (086538-0039); U.S. patent application Ser. No. 14/281,797, filed on May 19, 2014 (086538-0055); U.S. Patent App. No. 61/835,406, filed on Jun. 14, 2013 (086538-0032); U.S. Patent App. No. 61/904,376, filed on Nov. 14, 2013 (086538-0041); U.S. Patent App. No. 61/904,379, filed on Nov. 14, 2013 (086538-0043); U.S. Patent App. No. 61/835,461, filed on Jun. 14, 2013 (086538-0034); U.S. Patent App. No. 61/900,321, filed on Nov. 5, 2013 (086538-0040); and U.S. patent application Ser. No. 14/101,171, filed on Dec. 9, 2013 (086538-0046), the entireties of which are incorporated herein by reference.
According to some embodiments, the flow regulating implant can comprise an implant having a tubular structure and a calibrated, adjustable tapered end by which flow through the implant can be controlled.
According to some embodiments, a desired flow resistance through the implant may be achieved through a mechanical alteration of one or more components of the implant, such as a movable, compressible, slidable, self-expandable, balloon-expandable, or telescopic portion of the implant. According to some embodiments, adjustment of the flow rate, flow restriction, or flow resistance through the implant can be substantially irreversible (e.g., a permanent alteration, such as by modifying a shape of a plastically deformable, non-resilient material, cutting, or otherwise removing a portion of a component, etc.). However, in some embodiments, adjustment of the flow rate, flow restriction, or flow resistance through the implant can be reversible (e.g., a temporary alteration, such as deflecting a resilient material, changing relative positions of components, etc.).
The implant can comprise a plurality of components, such as a structure with a variable aperture (e.g., an adjustable diaphragm, a series of deflectable leaflets, etc.) at the distal end of the implant. The adjustable end of the implant can be controlled, for example, by a balloon, an engagement member, and/or longitudinal movement of the catheter. Further, modifications to the adjustable and of the implant can be made intermittently, and can be formed performed, while optionally checking the pressure in the channel.
The implant can be delivered by image-guided catheter. Imaging may be provided by fluoroscopy or ultrasound. Although in some embodiments, the implant can comprise a shunt having a substantially constant diameter along at least a portion thereof, the implant may comprise one or more portions that are either not expandable, balloon-expandable, or self-expandable. Further, one or more components of the implant can be expandable and/or self-expandable while one or more other components of the implant can be balloon-expandable and/or self-expandable.
Referring to
As shown in
Thus, the implant 2220 can be configured such that the position of the second component 2262 relative to the first component 2260 can operate to adjust or restrict flow through the implant 2220.
For example, as illustrated in
In accordance with some embodiments, although the first component 2260 can comprise a substantially constant diameter shunt along at least a portion thereof, the first component 2260 can comprise a substantially constant diameter portion and/or at least one expandable support member or portion (e.g., a stent or other structure (e.g., a braided, laser-cut, or coiled structure, etc., which can be self-expanding or balloon-expandable)) and/or at least one flexible member or sheath (e.g., a graft, PTFE cover, etc.). Further, the second component 2262 can comprise at least one expandable support member or portion (e.g., a stent or other structure (e.g., a braided, laser-cut, or coiled structure, etc., which can be self-expanding or balloon-expandable)) and/or at least one flexible member or sheath (e.g., a graft, PTFE cover, etc.). The first and second components 2260, 2262 can be manipulated, e.g., reconfigured or mechanically altered from one position to another, in order to provide a specific flow resistance or otherwise control a fluid flow rate through the first component 2260.
Therefore, in accordance with some embodiments, the second component 2262, whether formed integrally with or separately from the first component 2260 of the implant, can be movable, deformable, or otherwise mechanically alterable (by balloon or otherwise) in order to control or adjust a flow resistance or flow rate through the implant.
As noted herein, some embodiments of the implants and procedures disclosed herein can be used for the TIPS procedure. Accordingly, a given implant can be implanted so as to extend from a region of low pressure, such as the hepatic vein, to an area of high pressure, such as the portal vein. An implant, selected and configured to provide a specific resistance to flow, can be implanted and extend between the hepatic and portal veins, thus relieving some of the pressure from the portal vein. Optionally, the pressures of the portal and hepatic veins can be measured before and/or after the procedure.
In accordance with some embodiments, the implant can be implanted in a series of steps. For example, implant implantation may be performed in the following sequence. Initially, a first portion (proximal or distal) of the implant can be implanted (such as implanting the shunt or implant 2220 from the hepatic vein 2270 to the portal vein 2272, as shown in
In accordance with some embodiments,
A flow resistance or flow rate through the implant can determined, controlled, and/or modified by setting or adjusting the relative positions of the first and second components 2282, 2284 or otherwise modifying the configuration of at least one of the first and second components 2282, 2284, such as by using a balloon or mechanical alteration, such as cutting, folding, or otherwise removing a least a portion of at least one of the first and second components 2282, 2284. As noted above, the first component 2282 and/or the second component 2284 can comprise a substantially constant diameter portion and/or at least one expandable support member or portion (e.g., a stent or other structure (e.g., a braided, laser-cut, or coiled structure, etc., which can be self-expanding or balloon-expandable)) and/or at least one flexible member or sheath (e.g., a graft, PTFE cover, etc.).
In accordance with some embodiments, the first component 2282 can be formed from a braided material and comprise a preset tubular shape having a generally conical end. Further, the second component 2284 can comprise a plastically deformable structure, such as a non-resilient, laser cut conical structure that can be deformed by expansion, such as by balloon expansion, in order to increase the size of aperture 2286 of the second component 2284. Thus, in some embodiments, the size of the aperture 2286 can be increased in order to irreversibly decrease flow restriction through the aperture 2286. However, other embodiments can be configured for reversible or temporary flow restriction such that the flow restriction can be selectively increased or decreased, as desired.
For example,
Optionally, after the implant 2290 has been implanted into the patient, the pressure gradient can be measured and the position (i.e., flow restriction) through the implant 2290 can be increased or decreased in order to achieve a desired pressure gradient.
Additionally, some embodiments can be provided, as in
For example, in order to maintain the valve component 2302 in an open position, the slidable sections 2310 can be interconnected with a portion of the implant, such as with the frame 2312 using an engagement structure, such as hooks 2314. In use, the clinician can move the sections 2310 relative to the implant 2300 by disconnecting of one or more of the hooks 2314 in order to adjust the location of the sections 2310 relative to each other.
As illustrated
For example, as illustrated in
Furthermore, the engagement structure of the valve component 2302 can be deflectable from or biased toward an engaging position. For example, the hooks 2314 can be biased toward a collapsed position such that the hooks 2314 do not protrude into the vessel after being disengaged from the frame 2312. The hooks 2314 can comprise elongate protrusions or tabbed portions or cutouts attached to or formed from the slidable sections 2310.
Additional variability or adjustment of the valve component can be achieved using a variable diameter opening that is pressure sensitive. For example, a distal tip of the valve component can comprise a plurality of leaflets that are resiliently connected with the distal tip such that the leaflets are biased towards a first position in which a diameter of an aperture is maintained at a desired configuration. However, upon an increase in pressure through the implant, the leaflets can deflect from the first position toward a second position in which the leaflets are spread apart in order to allow the aperture to increase in size, thus reducing the flow restriction and permitting an increase in the flow rate or a reduction in flow resistance through the aperture.
For example, the second component 2360 can comprise a distal portion 2362 configured to contact the distal end 2354 of the implant 2350 in order to open the aperture 2356. In the illustrated embodiment, the distal end 2354 can comprise a plurality of leaflets 2364, the form an adjustable diaphragm. As the second component 2360 is urged distally, the distal portion 2362 can begin to push open the leaflets 2364 such that the aperture 2356 increases in size. As illustrated, the distal portion 2362 of the second component 2360 can be formed as a substantially conical shape in order to allow the second component 2362 incrementally contact the leaflets 2364, permitting a range of sizes or diameters for the aperture 2356. The second component 2360 can be moved towards a minimum flow restriction position, as in
Additionally, the second component 2360 can be secured within the first component 2352 at one of a plurality of positions when a desired flow gradient is achieved. As in other embodiments, the size of the aperture 2356 can be modified, such as by moving the second component 2360 to one of a variety of positions within the lumen of the first component 2352 in order to selectively increase or decrease flow restriction through the first component 2352. The movement of the second component 2360 can allow the operator to change the diameter of the aperture 2356. Optionally, the clinician can measure the pressure in the respective vessels, adjusting the position and/or size of the second component 2360 to achieve a desired gradient, until it the gradient is found to be satisfactory. Once the pressure gradient is determined to be satisfactory, the second component 2360 can be fixed in position so as not to permit further closing or opening of the aperture 2356.
Flow can also be adjusted by balloon-assisted means.
In some embodiments, the support component 2410 can comprise a self-expanding helical member extending along a distal portion of the catheter implant 2404. Once the assembly 2400 is advanced to the target area within the vasculature, the support component 2410 can be permitted to expand from a collapsed position, as shown in
As illustrated in
The cover component 2412 can be attached to the tapered section 2432 or otherwise biased toward a closed position (shown in
The cover component 2412 can comprise a flexible or rigid material that is attached to or positioned around the tapered section 2432. A first end 2440 of the cover component 2412 can be attached to one or more portions of the support component 2410. For example, as shown in
In accordance with some embodiments, the cover component 2412 can comprise a plurality of deflectable leaflets that are configured to slide or move relative to each other in order to increase or decrease the size of the aperture 2414. However, as also disclosed in accordance with other embodiments, the cover component 2412 can be adjusted by mechanically altering an attribute, size, or shape of the cover component 2412, such as by balloon expansion or by cutting or otherwise further opening the distal diameter thereof.
For example,
Although
For example,
In accordance with some embodiments, the implants disclosed herein can be implanted and/or adjusted using any of a variety of balloon shapes, such as those illustrated in
Some embodiments are also provided by which the assembly and/or catheter can be advanced over a guidewire, thus allowing treatment of more tortuous or distal, smaller vessels in the vasculature. Other features and characteristics of the assembly and/or catheter can be modified to include any of the structures or features discussed above, or as those disclosed in: U.S. patent application Ser. No. 12/826,593, filed on Jun. 29, 2010 (086538-0012); U.S. patent application Ser. No. 13/367,338, filed on Feb. 6, 2012 (086538-0018); U.S. patent application Ser. No. 12/906,993, filed on Oct. 18, 2010 (086538-0014); U.S. patent application Ser. No. 13/828,974, filed on Mar. 14, 2013 (086538-0030); U.S. Patent Application No. 61/836,061, filed on Jun. 17, 2013 (086538-0038); U.S. patent application Ser. No. 14/044,794, filed on Oct. 2, 2013 (086538-0039); U.S. patent application Ser. No. 14/281,797, filed on May 19, 2014 (086538-0055); U.S. Patent App. No. 61/835,406, filed on Jun. 14, 2013 (086538-0032); U.S. Patent App. No. 61/904,376, filed on Nov. 14, 2013 (086538-0041); U.S. Patent App. No. 61/904,379, filed on Nov. 14, 2013 (086538-0043); U.S. Patent App. No. 61/835,461, filed on Jun. 14, 2013 (086538-0034); U.S. Patent App. No. 61/900,321, filed on Nov. 5, 2013 (086538-0040); and U.S. patent application Ser. No. 14/101,171, filed on Dec. 9, 2013 (086538-0046), the entireties of which are incorporated herein by reference.
Some embodiments provide for advantageously configured distal structures that allow the delivery device to move smoothly through a catheter or body lumen with minimal force. For example, some embodiments comprise a delivery device that has a flexible, torque resistant distal tip configured to support or carry a medical implant. In some embodiments, a torque resistant distal tip can be segmented and/or coiled, such that the distal tip is able to flex, separate, or deflect to a greater extent than a solid tube. In some embodiments, a torque resistant distal tip provides high column strength in response to axially compressive forces. For example, column strength may be maintained for transmitting axial forces while providing enhanced flexibility to yield to lateral forces.
Some embodiments of the delivery device or catheter can provide a flexible core over which an implant may be loaded. The implant can be configured and loaded or wound onto the distal tip of the catheter such that the implant is maintained in a collapsed configuration by virtue of torque resistance provided by the distal tip of the catheter. When loaded onto the distal tip and in the collapsed or delivery configuration, the implant can transmit torque to the core in order to maintain a deliverable diameter.
The design of the carrier tip is intended to allow flexibility of the catheter tip, while holding an implant frame in its pre-deployment position. The tip further resists torque applied to the tip by an implant secured onto the tip. The tip provides a counter torque in response to the implant, thereby providing a segmented design for greater flexibility without being adversely impacted by a coiled implant secured to the tip in a compressed state.
Referring now to
According to some embodiments, the middle portion 2614 generally forms a tubular shape. A coil 2615 is formed along the middle portion 2614 by cutting a helical kerf 2616 along the length of the tubular middle portion 2614. As used here, “kerf” is a slit that extends from an outer surface of the catheter 2600 to a lumen 2604 of the catheter 2600. The coil 2615 is defined by the structure that remains after the kerf 2616 is cut. Both the coil 2615 and the kerf 2616 follow helical paths in the same direction (e.g., levorotary/“right-handed” or dextrorotary/“left-handed”). The coil 2615 may be formed by providing the kerf 2616 to a generally tubular structure. The generally tubular structure defining the middle portion 2614—as well as the proximal portion 2610 and the distal portion 2612—may be of a metallic material, such as stainless steel or nitinol. The material may have shape memory characteristics. The kerf 2616 may be provided by laser cutting, mechanical cutting, electrical discharge machining, etching, combinations thereof, and the like. Accordingly, the coil 2615 of the middle portion 2614 may be integrally connected to the proximal portion 2610 and/or the distal portion 2612.
The kerf 2616 may have a consistent pitch or varying pitch along the length of the middle portion 2614. Accordingly, the coil 2615 may have, at any segment thereof, the same or different longitudinal lengths extending between axially adjacent sections of the curve 2616. According to some embodiments, more than one kerf 2616 may be provided, such that each of the kerf 2616 are in the same helical direction and such that they do not cross or overlap.
The kerf 2616 provides a gap between adjacent segments along a longitudinal length of the middle portion 2614. As such, first and second sides 2617a and 2617b of segments of the coil 2615 disposed across a portion of the kerf 2616 are able to separate as needed in response to a bending force applied to the middle section 2614. The first and second sides 2617a, 2617b can separate on one radial side of the middle portion 2614 and approach each other or contact each other on an opposite radial side of the middle portion 2614 to curve and bend. The ability of the first and second sides 2617a, 2617b to separate on any radial side of the middle portion 2614 provides flexibility to the middle portion 2614. Whereas the support frame 2650 increases overall rigidity of the assembly when applied to the catheter 2600, the ability of the coil 2615 to flex and bend increases the combined flexibility of the support frame 2650 and the middle portion 2614.
As shown in
The kerf 2616 and the coil 2615 of the catheter 2600 may be oriented in a helical direction. The helical kerf 2616 and coil 2615 provide counter torque capabilities in response to a torque applied by the support frame 2650. A helically directed kerf, rather than a kerf along a longitudinal path or a partial circumferential path orthogonal to a longitudinal axis, can provide a continuous gap along an entire circumference of the middle portion 2614. In contrast, a circumferential gap orthogonal to a longitudinal axis can only be partially circumferential in order to maintain a longitudinal continuity along the length of the middle portion 2614. The helically directed kerf allows the first and second sides 2617a, 2617b to separate at any circumferential location. The helical direction of the kerf 2616 and/or the coil 2615 can be opposite the helical direction of the support frame 2650. For example, as shown in
The torque applied to the catheter 2600 causes the proximal and distal portions 2610, 2612 to tend to rotate relative to each other. In response, the coil 2615 of the middle portion 2614 tends to compress radially and/or expand longitudinally. Where longitudinal expansion is limited, such as by tension applied by the support frame 2650, the tendency of the middle portion 2614 to compress radially causes opposing first and second sides 2617a, 2617b across the kerf 2616 to move toward each other and decrease the size of the gap defined by the kerf 2616. When the first and second sides 2617a, 2617b engage each other, further radial compression of the middle portion 2614 is limited, and the torque provided by the support frame 2650 is matched by the engagement of the first and second sides 2617a, 2617b.
Referring now to
As shown in
As shown in
As shown in
As shown in
Therefore, the catheter 2600 provides enhanced flexibility for traversing tortuous vascular anatomy while resisting torque applied to the catheter 2600 by a support frame 2650 secured thereto.
Referring now to
According to some embodiments, the middle portion 2814 generally forms a tubular shape. A plurality of filaments 2815 are provided along the middle portion 2814. The plurality of filaments 2815 each follow a path in a helical direction (e.g., levorotary/“right-handed” or dextrorotary/“left-handed”). The helical direction of each filament 2815 may be the same as the helical direction of every other filament 2815, such that only filaments in a given helical direction are provided. Alternatively, the helical direction of some of the filaments 2815 may be opposite the helical direction of others of the filaments 2815 (not shown). In such a configuration, the filaments 2815 may cross at intersection points to form a woven pattern. The filaments 2815 may have the same or different pitches. Each filament 2815 may have a consistent pitch or variable pitch. The filaments 2815 may have the same or different widths. Each filament 2815 may have a consistent width or a variable width along its length. The filaments 2815 may be equally or unequally spaced along a longitudinal length of the middle portion 2814. The filaments 2815 may be equally or unequally distributed circumferentially at either or both of the proximal and distal portions 2810, 2812.
The filaments 2815—as well as the proximal portion 2810 and the distal portion 2812—may be of a metallic material, such as stainless steel or nitinol. The filaments 2815 may be of the same or different materials. The material(s) may have shape memory characteristics. The filaments 2815 may be cut from a generally cylindrical tube section between the proximal and distal portions 2810, 2812 by laser cutting, mechanical cutting, electrical discharge machining (EDM), chemical etching, combinations thereof, and the like. Accordingly, the filaments 2815 of the middle portion 2814 may be integrally connected to the proximal portion 2810 and/or the distal portion 2812. Alternatively or in combination, the filaments 2815 may be formed apart from the proximal and distal portions 2810, 2812 and subsequently attached thereto (e.g., by adhesive bonding or welding).
The filaments 2815 are arranged to provide a gap between adjacent filaments 2815 along a longitudinal length of the middle portion 2814. As such, the filaments 2815 are able to separate from each other as needed in response to a bending force applied to the middle section 2814. The filaments 2815 can separate on one radial side of the middle portion 2814 and approach each other or contact each other on an opposite radial side of the middle portion 2814 to provide overall flexibility. The ability of the filaments 2815 to separate on any radial side of the middle section 2814 provides flexibility to the middle section 2814. Whereas the support frame 2850 increases overall rigidity of the assembly when applied to the catheter 2800, the ability of the filaments 2815 to flex and bend increases the combined flexibility of the support frame 2850 and the middle portion 2814.
As shown in
The filaments 2815 of the catheter 2800 may be oriented in a helical direction opposite the helical direction of the support frame 2850. For example, as shown in
The torque applied to the catheter 2800 causes the proximal and distal portions 2810, 2812 to tend to rotate relative to each other. In response, the filaments 2815 of the middle portion 2814 tend to compress radially and/or expand longitudinally. Where longitudinal expansion is limited, such as by tension applied by the support frame 2850, the tendency of the middle portion 2814 to compress radially causes adjacent filaments 2815 to move toward each other and decrease the size of the gap defined there between. The space between adjacent pairs of filaments 2815 may be eliminated, such that the filaments 2815 form a closed coil. When adjacent filaments 2815 engage each other, further radial compression of the middle portion 2814 is limited, and the torque provided by the support frame 2850 is matched by the engagement of the filaments 2815.
Therefore, the catheter 2800 provides enhanced flexibility for traversing tortuous vascular anatomy while resisting torque applied to the catheter 2800 by a support frame 2850 secured thereto.
Implant deployment can be performed as a two stage process, which is illustrated in
Features of any of the implants, the support frames, and/or the membranes disclosed herein can be applied to other devices and implants disclosed herein. Any implant of the present disclosure may be configured to interact with structures of an engagement structure of a catheter disclosed herein. Features of a membrane disclosed herein can be applied to other membranes or implants disclosed herein.
According to some embodiments of the subject technology, the support frame may comprise at least one of stainless steel, nickel titanium (NiTi), cobalt chromium (CoCr), titanium, a polymer, a polyester based material, a tyrosine based polycarbonate, a polyethylene based material, Teflon (e.g., including expanded Teflon), and other suitable materials known to those of ordinary skill in the art. In some embodiments, support frame 302 may comprise at least one of polyethylene, polyglicolide, polylactide, ε-caprolactone, polycarbonate, hydroxyalkanote, para dioxinine, polytetrafluoroethylene (PTFE), expanded polytetrafluoroethylene (ePTFE), PLA, PGA, PLLA, PDLLA, PDO, PCL, and other suitable materials known to those of ordinary skill in the art. In some embodiments, support frame and/or occlusion membrane 304, may comprise a bioabsorbable material, beneficially allowing for their controlled degradation. In some embodiments, support frame and/or occlusion membrane may be formed of bioabsorbable material to have a controlled degradation anywhere between about 3 months to about 3 years depending on the desired application of support frame. In some embodiments, the controlled degradation may be less than about 3 months or greater than about 3 years. For example, hydrolysis of ester linkages or effects of enzymatic degradation may be utilized for the controlled degradation.
In some embodiments, the support frame may be coated with various suitable agents to allow support frame to expand within and engage the inner surface of the vessel or lumen. For example, support frame may be coated with biological glue. In some embodiments, support frame may be coated with a friction-resistant coating (e.g., a friction-resistant polymer coating). In some embodiments, radio-opaque markers may be located on support frame or occlusion membrane for endovascular or other image-guided procedures. In some embodiments, the radio-opaque marker may be a platinum iridium alloy or other suitable markers known to those of ordinary skill in the art.
According to various embodiments of the subject technology, occlusion membrane 304 may be used to occlude, partially or completely, luminal structure in which an implant is deployed. In some embodiments as used herein, occlusion may refer to either partial or complete occlusion.
According to some embodiments, implants disclosed herein can incorporate any one or more of the features disclosed in the Figures or discussion herein. For example, any of the implants can be configured to comprise a fibrous membrane feature, as discussed above.
According to some embodiments, implants disclosed herein can have an expanded diameter of between about 4 mm to about 22 mm. Additionally, some embodiments can be used in vessels having diameters between about 3 mm to about 20 mm.
According to some embodiments, implants disclosed herein can be deployed in vessels having dimensions of between about 3 mm to about 20 mm. The target delivery profile can be about 8 Fr, about 7 Fr, about 6 Fr, about 5 Fr, about 4 Fr, about 3 Fr, or smaller.
Furthermore, implants disclosed herein can also be configured for use in venous stenting and can comprise any of the features taught herein to facilitate such use, including incorporating a fibrous membrane into the implant frame. For example, stenting of vessels having diameters between about 3 mm to about 20 mm can be possible using embodiments disclosed herein. This exceptional and advantageous ability of embodiments of the medical implants disclosed herein to provide stenting in such small vessels is made possible, for example, due to the minimal delivery profile can be achieved using such embodiments. As noted above with other embodiments, deployment of an implant having a fibrous membrane feature can exert an outward radial force against inside wall of a vein in order to improve blood flow, or minimize vein insufficiency. Further, the delivery profile can be about 8 Fr or smaller, as discussed herein.
According to various aspects of the subject technology, implants disclosed herein may be used for various applications for reducing or stopping flow through a luminal structure in a patient. Implants of the subject technology may be used for rapid, well-controlled, and reliable occlusion of luminal structures. For example, the luminal structure may comprise at least one of a blood vessel, a body organ, a lung, an airway, a Fallopian tube, a cervical canal, a vagina, a cervix, a vas deferens, a bronchus, a ureter, a colon, a rectum, an anus, a bio duct, a pancreatic duct, or other suitable tubular structures known to those of ordinary skill in the art. In some embodiments, implants of the present disclosure may be used for temporary occlusion in cases of lung disease, or for temporary occlusion of female reproductive organs for contraceptive purposes. In some embodiments, implants of the present disclosure may be removed, or flow may be restored through the luminal structure to restore original organ functions.
In some embodiments, implants of the present disclosure may be used for various endoluminal occlusion procedures, including procedures for the lungs (e.g., selective endobronchial occlusion for lung reduction, occlusion of bronchopleural or bronchocutaneous fistulas, endovascular occlusion of pulmonary AVMs and fistulas or aortopulmonary anastomoses) and procedures for reproductive organs (e.g., endoluminal occlusion of vas deferens or Fallopian tubes for minimally-invasive contraceptive intervention, endovascular occlusion of varicocele in males and low abdominal gonadal veins for reducing or completely eliminating chronic pelvic pain syndrome in females). In some embodiments, implants of the present disclosure may be used for stopping blood loss from a damaged blood vessel, closing an abnormal blood vessel or a blood vessel supplying a vascular anomaly, or interrupting blood supply to an organ or part of an organ for permanent devascularization (e.g., closure of splenic artery in spleen laceration, devascularization of tissues involved by neoplastic process, either pre-operatively or as a palliative measure). In some embodiments, implants of the present disclosure may be used for various endovascular (e.g., neural and peripheral) procedures including procedures for giant cerebral and skull base aneurysms (ruptured and non-ruptured), head and neck arteriovenous fistulas, dissecting intracranial and extracranial vessels, traumatic and non-traumatic vessel injury or rupture (e.g., pelvic hemorrhages in trauma patients, carotid blow-out in patients with head and neck cancers, hemorrhage induced by a neoplasia, etc.), and devascularization prior to (or as an alternative to) surgical resection of various organs or tumors.
In certain embodiments, implants of the present disclosure may be used for various organs, including for example, the spleen (e.g., endovascular occlusion as a preoperative intervention or as an alternative to surgical resection with indications including traumatic hemorrhage, hypersplenism, bleeding secondary to portal hypertension or splenic vein thrombosis, and various disorders such as thalassemia major, thrombocytopenia, idiopathic thrombocytopenic purpura, Gaucher disease, and Hodgkin disease), the liver (e.g., occlusion of portal veins collaterals as adjunct to a transjugular intrahepatic portosystemic shunt (TIPS), occlusion of the TIPS itself in cases of encephalopathy, occlusion of intrahepatic arterioportal fistulas), the kidney (e.g., endoluminal ureteral occlusion for intractable lower urinary tract fistula with urine leakage, or for the treatment of uretero-arterial fistulae, endovascular occlusion as an alternative to surgical resection for end-stage renal disease or renovascular hypertension requiring unilateral or bilateral nephrectomy and renal transplant with native kidneys in situ), and the heart (e.g., occlusion of coronary arteriovenous fistulas, transarterial embolization of Blalock-Taussig shunts). The application of implants of the present disclosure is not limited to applications for human patients, but may also include veterinary applications.
According to some embodiments, a cover component or patch can be attached to an implant. Cover components may be attached to one or both ends or an implant and/or a middle region of an implant.
According to various embodiments of the subject technology, a cover component of an implant may be used to occlude, partially or completely, luminal structure in which a respective implant is deployed. In some embodiments as used herein, occlusion may refer to either partial or complete occlusion. In some embodiments, cover components can comprise at least one of a polyurethane, a polyanhidrate, PTFE, ePTFE, silicone, and other suitable materials known to those of ordinary skill in the art. In some embodiments, cover components may be elastic. In some embodiments, cover components may be permeable or non-permeable.
In some embodiments, an average thickness of a cover component can be between about 0.0005 inches and about 0.006 inches. In some aspects, the average thickness of a cover component may be less than about 0.0005 inches or greater than about 0.006 inches. In certain embodiments, an average thickness of a distal portion of a cover component is greater than an average thickness of a proximal portion of a cover component. Such a configuration may ensure that more flow may be reduced at the distal portion of a cover component. In some embodiments, the average thickness of the distal portion of a cover component is between about 0.002 inches and about 0.012 inches. In some embodiments, the average thickness of the distal portion of a cover component may be less than about 0.002 inches or greater than about 0.012 inches. In some embodiments, the average thickness of the proximal portion of a cover component is between about 0.0005 inches and about 0.006 inches. In some embodiments, the average thickness of the proximal portion of a cover component may be less than about 0.0005 inches or greater than about 0.006 inches.
The foregoing description is provided to enable a person skilled in the art to practice the various configurations described herein. While the subject technology has been particularly described with reference to the various Figures and configurations, it should be understood that these are for illustration purposes only and should not be taken as limiting the scope of the subject technology.
There may be many other ways to implement the subject technology. Various functions and elements described herein may be partitioned differently from those shown without departing from the scope of the subject technology. Various modifications to these configurations will be readily apparent to those skilled in the art, and generic principles defined herein may be applied to other configurations. Thus, many changes and modifications may be made to the subject technology, by one having ordinary skill in the art, without departing from the scope of the subject technology.
It is understood that the specific order or hierarchy of steps in the processes disclosed is an illustration of exemplary approaches. Based upon design preferences, it is understood that the specific order or hierarchy of steps in the processes may be rearranged. Some of the steps may be performed simultaneously. The accompanying method Claims present elements of the various steps in a sample order, and are not meant to be limited to the specific order or hierarchy presented.
As used herein, the phrase “at least one of” preceding a series of items, with the term “and” or “or” to separate any of the items, modifies the list as a whole, rather than each member of the list (i.e., each item). The phrase “at least one of” does not require selection of at least one of each item listed; rather, the phrase allows a meaning that includes at least one of any one of the items, and/or at least one of any combination of the items, and/or at least one of each of the items. By way of example, the phrases “at least one of A, B, and C” or “at least one of A, B, or C” each refer to only A, only B, or only C; any combination of A, B, and C; and/or at least one of each of A, B, and C.
Terms such as “top,” “bottom,” “front,” “rear” and the like as used in this disclosure should be understood as referring to an arbitrary frame of reference, rather than to the ordinary gravitational frame of reference. Thus, a top surface, a bottom surface, a front surface, and a rear surface may extend upwardly, downwardly, diagonally, or horizontally in a gravitational frame of reference.
Furthermore, to the extent that the term “include,” “have,” or the like is used in the description or the Claims, such term is intended to be inclusive in a manner similar to the term “comprise” as “comprise” is interpreted when employed as a transitional word in a Claim.
The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments.
A reference to an element in the singular is not intended to mean “one and only one” unless specifically stated, but rather “one or more.” Pronouns in the masculine (e.g., his) include the feminine and neuter gender (e.g., her and its) and vice versa. The term “some” refers to one or more. Underlined and/or italicized headings and subheadings are used for convenience only, do not limit the subject technology, and are not referred to in connection with the interpretation of the description of the subject technology. All structural and functional equivalents to the elements of the various configurations described throughout this disclosure that are known or later come to be known to those of ordinary skill in the art are expressly incorporated herein by reference and intended to be encompassed by the subject technology. Moreover, nothing disclosed herein is intended to be dedicated to the public regardless of whether such disclosure is explicitly recited in the above description.
While certain aspects and embodiments of the inventions have been described, these have been presented by way of example only, and are not intended to limit the scope of the inventions. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms without departing from the spirit thereof. The accompanying Claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the inventions.
Claims
1. A method of assembling an implant delivery system, comprising:
- providing an implant, in a relaxed state, to a catheter having a Iced extending in a first helical direction and defining opposing sides along a helical coil;
- engaging a first end portion of the implant with a proximal portion of the catheter; and
- engaging a second end portion of the implant with a distal portion of the catheter; such that the implant is held in a torsion torsional state by the catheter, and such that the implant applies a torque to the catheter.
2. The method of claim 1, wherein the kerf has a non-linear profile following a helical path.
3. The method of claim 1, wherein the torque causes the opposing sides of adjacent windings of the coil between the proximal portion and the distal portion to be pulled toward each other.
4. The method of claim 1, wherein the implant further comprises a helical member extending in a second helical direction, opposite the first helical direction.
Type: Application
Filed: May 1, 2017
Publication Date: Oct 19, 2017
Patent Grant number: 10441290
Inventors: Leon RUDAKOV (San Marcos, CA), Andrew Black (Johnsburg, IL), Andrew R. Leopold (Hawthorn Woods, IL), Kelly Jensen (Palatine, IL)
Application Number: 15/583,956
